The Institute of Medicine recently released a report that explores the effect of resident duty hours, schedules, supervision, patient caseloads and handovers on patient safety and medical education.  The report, entitled Resident Duty Hours:  Enhancing Sleep, Supervision, and Safety, did not recommend changes to the 80-hour work limit, but did make recommendation for maximum shift length (from 30 to 16 hours with some modifiers), minimum time off and moonlighting, and recommended guidelines for maximum frequency of in-hospital night shifts. 

Among the report’s key recommendations are:

• Provide residents a five-hour break for sleep within shifts that last up to 30 hours.

• Provide variable off-duty periods between shifts based on the timing and duration of shifts to increase residents’ opportunities for sleep each day, as well as regular days off that enable residents to recover from chronic sleep deprivation.

• Restrict residents’ medical moonlighting, defined as additional paid health care work.

• Provide safe transportation to any resident too fatigued to drive home safely.

• Change monitoring practices to include ­unannounced visits and strengthen whistle-blower processes to encourage resident reporting of violations of limits and undue pressure to work too long.

• Ensure patient workload that is appropriate to learning and reduce the amount of non-educational work for residents, as well as improve supervision of residents with more frequent consul­tations between residents and their supervisors.

• Require specialty-specific guidelines for the number of patients that residents should be permitted to treat during a shift, based on the level of residents’ competency and patient characteristics.

• Schedule shift changeovers to ensure adequate over­lap time to conduct effective handovers.
  

• Teach residents error detection, correction, reporting and monitoring so they can participate fully in the hospital’s quality improvement efforts.                                        

You may read the report’s full text and executive summary online or purchase the report at http://www.nap.edu/catalog.php?record_id=12508.  A summary table of the report’s recommendations is available at http://www.iom.edu/Object.File/Master/60/471/one%20pager%20revised%20for%20web%202.pdf.  The report brief is posted at http://www.iom.edu/Object.File/Master/60/469/residency%20hours%20revised%20for%20web.pdf