Duty hours in emergency medicine: balancing patient safety, resident wellness, and the resident training experience: a consensus response to the 2008 Institute of Medicine resident duty hours recommendations.
BACKGROUND
Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated.


CONCLUSIONS
The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked.


CONCLUSIONS
One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.
Wagner
Mary Jo
MJ
Michigan State University, East Lansing, Michigan, USA.
Wolf
Stephen
S
Promes
Susan
S
McGee
Doug
D
Hobgood
Cheri
C
Doty
Christopher
C
McErlean
Mara Ann
MA
Janssen
Alan
A
Smith-Coggins
Rebecca
R
Ling
Louis
L
Mattu
Amal
A
Tantama
Stephen
S
Beeson
Michael
M
Brabson
Thomas
T
Christiansen
Greg
G
King
Brent
B
Luerssen
Emily
E
Muelleman
Robert
R
D026683:Advisory Committees; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D010561:Personnel Staffing and Scheduling; D017751:Safety Management; D014481:United States