Despite regulations, many surgeons still struggle with fatigue

In an effort to reduce fatigue-related medical errors among notoriously overworked surgical residents, the Accreditation Council for Graduate Medical Education implemented new policies in 2003 that limit residents’ on-duty hours. Surgical residents are now limited to 80 on-duty hours per week and must have a minimum break of 10 hours between shifts. However, recent studies on the effectiveness of these measures suggest that the issue is far from resolved.

Researchers who studied the effects of fatigue on surgeons in 2010 and 2011 found that participants slept an average of just 5.3 hours per night, Reuters reported. While awake, these surgeons were so fatigued that about 25 percent of the time they experienced impairments equivalent to being legally drunk, according to the study led by Dr. Frank McCormick of the Harvard Orthopaedic Combined Residency Program in Boston.

Surgeon fatigue mimics intoxication

Compared to well-rested surgical residents, researchers found that the sleep-deprived doctors functioned at just 70 percent of their mental effectiveness roughly a quarter of the time that they were awake. The authors of the study say this level of decreased brain functioning is equivalent to having a blood alcohol level of 0.08, the level of intoxication at which it becomes illegal to drive. Surgeons experiencing that level of fatigue were 22 percent more likely to cause a medical error than well-rested doctors, the researchers found.

As the study suggests, fatigue remains a very real concern in today’s hospitals, despite the new policies. In some cases, noncompliance with on-duty time limitations may be a factor. In 2011, Reuters reported on findings that a majority of surgical residents exceeded the maximum on-duty hours permitted by current regulations.

However, a more recent study by HOCRP found that the work-hour limitations are having a positive effect – though not necessarily in the ways that were expected. The new study compared data gathered from 216 surgical residents between 2003 and 2009, and found that those surveyed in 2009 spent significantly fewer on-duty hours per week than their 2003 counterparts. But contrary to what one might expect, working fewer hours did not translate into more sleep for most of the residents: The doctors surveyed reported sleeping an average of about five hours per night throughout the study period.

Survey shows mixed results

Despite failing to get more sleep, however, the residents in the later group reported feeling less fatigued and said that they made fewer fatigue-related medical errors. In 2003, 46 percent of residents surveyed said their fatigue had a negative impact on the quality of care they provided, compared to 26 percent of those surveyed in 2004 through 2009. Researchers say this could be a result of other benefits that may be derived from working fewer hours, such as reduced psychological stress and improved overall wellbeing.

People who have been harmed by medical errors in Pennsylvania are encouraged to consult with an experienced medical malpractice attorney to discuss the possibility of seeking financial compensation for medical bills, rehabilitation, lost income and other losses resulting from the harm.

Attorney Cliff Rieders

Cliff Rieders is a Nationally Board Certified Trial Lawyer practicing personal injury law. A large part of his practice involves multi-district litigation, including cases related to pharmaceuticals, vitamin supplements and medical devices. He is admitted in several state and federal courts, as well as the Supreme Court of the United States. Rieders is the past regional president of the Federal Bar Association and is a life member of the distinguished American Law Institute, which promulgates proposed rules adopted by many state courts. He is a past president of the Pennsylvania Association for Justice, formerly Pennsylvania Trial Lawyers Association. As a founder of the Pennsylvania Patient Safety Authority, he served on the Board for 15 years.

Not only has Rieders held many highly esteemed, leadership positions, he authored legislation related to the Patient Safety Authority and the Mcare Act, which governs medical and hospital liability actions in Pennsylvania. He authored texts upon which both practitioners and judges rely, including Pennsylvania Malpractice Laws and Forms, and Financial Responsibility Law Issues in Pennsylvania, the latter governing auto and truck collisions in Pennsylvania. In addition, he wrote several books on the practice of law in Pennsylvania regarding wrongful death and survivor actions, insurance bad faith, legal malpractice claims and worker rights, among others. Rieders also serves as a resource to practitioners as a regular speaker for Celesq, an arm of the world’s largest legal publisher, Thomson Reuters West Publishing.

As recognition of his wide range of contribution to his profession and of his dedication to protecting the rights of his clients, he received numerous awards, among them the George F. Douglas Amicus Curiae Award, the Milton D. Rosenberg Award, the B’nai B’rith Justice Award, and awards of recognition from the Pennsylvania Trial Lawyers. [ Attorney Bio ]