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Miscommunication and Fatigue Among Medical Residents as a Cause of Hospital Errors

A frequent cause of hospital errors is poor communication between staff members. When patients are constantly shuttled from one department to another, or from one caregiver to another, the chance of miscommunication keep increasing. And far too often, the result of that miscommunication is medical errors.

Many of these errors relate to the heroic myth that still influences the training of medical residents. Doctors-in-training are expected to be available for so many hours at a time that fatigue puts patients at risk. This has been a known issue for so long that the medical profession can no longer ignore the problem.

Last summer, the Accreditation Council for Graduate Medical Education proposed limits on the number of hours that medical residents are allowed to work. One of the elements of the proposal was to limit the workday of first-year residents to 16 hours.

The Mayo Clinic recently surveyed the directors of 464 medical training programs around the country. Most respondents expressed concerns about the proposals. The fear was that the limits on work hours would interfere with the residents' capacity to provide and coordinate continuous patient care.

Nor did the training program directors believe that the proposed work limits would actually reduce fatigue among medical residents. Nearly two-third of the respondents (65 percent) said that it would not. One concern is that residents could end up trying to cram even more work into the hours they have - leaving them still fatigued and prone to commit errors.

This suggests that, when the training program changes take effect this July, hospitals need to take additional steps to prevent fatigue and medical errors. They could, for example, consider adding more nurses, even though that would cost money.

Source: "Medical Residency Directors Don't Think Work Limits Will cut Fatigue," WSJ, 3-1-11

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