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I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time

I used to work in hospital IT at a level 1 trauma center from 2004-2006. While I was there, an article was released which studied the relationship between time on shift and errors made by staff. As I recall (and it has been 10 years) the findings were: * Through roughly 9 hours, the error rate was about the same. Say, x% * In the 10th hour, the error rate increased. Say x + y%. * In hours 11 and 12, the amount the error rate increase doubled the 10th hour's increase. So x + 2y%. * In hours 13 and 14, the amount the error rate increase quadrupled the 10th hour's increase. So x + 4y%. * In every subsequent hour studied, the error rate increase doubled again. x + 8y% in hour 15, x + 16y% in hour 16. I want to say the study went to 18 hours, but I don't recall if it was 16 or 18 at this point. The paper made the recommendation that shift lengths should be limited to 10 hours maximum. Every health care professional I spoke to about the article (resident doctors and nurses, maybe 10 overall, mostly in the ER) said the same three things: 1. They had personally witnessed someone make an error they could attribute to tiredness. 2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem.

technofiend 8y ago
2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem. I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.

technofiend 8y ago

2. They themselves had never made a mistake due to tiredness. 3. They didn't want to change their schedule. Either they liked having 4 days off every week, or they thought it wasn't a significant problem. I think those two items and the tribal knowledge that handoffs are more dangerous to the patient helps the overwork model persist. Sounds like it's past time the medical industry prove that handoffs are more dangerous to patient outcomes. Doctors are trained to be problem owners and problem solvers, but that doesn't make them good team players. And lowering handoffs also limits oversight and prevents second guessing which is great if you're convinced you're always right, but clearly doctors are not always right and patients often pay the price.