title: 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.
abstract: 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 (ACGME), the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. 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 on-site supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. One recommendation from the IOM was a required 5-hour 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.
authors.affiliation: Michigan State University, East Lansing, USA. mjwagner@cris.com
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Wagner
authors.forename: Stephen
authors.initials: S
authors.lastname: Wolf
authors.forename: Susan
authors.initials: S
authors.lastname: Promes
authors.forename: Doug
authors.initials: D
authors.lastname: McGee
authors.forename: Cheri
authors.initials: C
authors.lastname: Hobgood
authors.forename: Christopher
authors.initials: C
authors.lastname: Doty
authors.forename: Mara Ann
authors.initials: MA
authors.lastname: McErlean
authors.forename: Alan
authors.initials: A
authors.lastname: Janssen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith-Coggins
authors.forename: Louis
authors.initials: L
authors.lastname: Ling
authors.forename: Amal
authors.initials: A
authors.lastname: Mattu
authors.forename: Stephen
authors.initials: S
authors.lastname: Tantama
authors.forename: Michael
authors.initials: M
authors.lastname: Beeson
authors.forename: Thomas
authors.initials: T
authors.lastname: Brabson
authors.forename: Greg
authors.initials: G
authors.lastname: Christiansen
authors.forename: Brent
authors.initials: B
authors.lastname: King
authors.forename: Emily
authors.initials: E
authors.lastname: Luerssen
authors.forename: Robert
authors.initials: R
authors.lastname: Muelleman
mesh_terms: D003245:Consensus Statements as Topic; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000191:economics / Q000639:trends*; D005221:Fatigue / Q000517:prevention & control; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D010561:Personnel Staffing and Scheduling; D012449:Safety; D014481:United States; D014940:Work Schedule Tolerance; D016526:Workload