> So long shifts are due to errors ? I hardly see the logic in that...
There is no logic in that, i'm not sure why you asserted that. I noted that long shifts reduce handoff errors.
Consider two scenarios: Scenario 1: 8 hour shifts:
Doctor 1 hands off to Doctor 2 at end of 8 hrs
Doctor 2 hands off to Doctor 3 at end of 16 hrs
Doctor 3 hands off to Doctor 4 (or perhaps 1) at end of 24hrs
Each handoff is a game of telephone. In theory it should not be, but in reality it is. Details are missed, directions mangled, and risk accrued. Just like a technical design document going from a product manager to the development lead to the developer...things go wrong in the process.
Just like with tech teams where each added person creates overhead and waste from communications overhead and mis-aligned understanding of requirements, hospitals face the same issue. Unlike technology, you dont just push a fix and rebuild -- an error such as forgetting to record a symptom on the binder/EMR could mean mis-diagnosis or death. Shifting to 12-hours shifts means just two handoffs instead of three. You dont eliminate errors, but you reduce them. In some sense, it may be better to have 4 days of 12-hour shifts than 5 days of 8 hour shifts.
Of course, this is just one aspect of medical errors. There are others which may be brought on by increased shift lengths. We'd need to look at the total sum.
Regarding your other point:
> In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week,
That makes no sense. If that were the case, residents would choose to work an hour a week and easily graduate in 3-5 years. But that would make for a poor doctor, as they need a certain # hours of training.
> There is no logic in that, i'm not sure why you asserted that. I noted that long shifts reduce handoff errors.
Consider two scenarios: Scenario 1: 8 hour shifts: Doctor 1 hands off to Doctor 2 at end of 8 hrs Doctor 2 hands off to Doctor 3 at end of 16 hrs Doctor 3 hands off to Doctor 4 (or perhaps 1) at end of 24hrs
Each handoff is a game of telephone.
This is not how this works. You either have acute patients who would indeed need handoffs between day and night teams, and you have programmed patients who usually do not need any handoff. Acute patients are usually managed by very specialized teams both in terms of managing physicians, nurses, and usually residents are not alone at night. Those patients are also indirectly managed by other specialists, wether it be the surgical teams, or the imagery team on call. They are also hooked to at least an EKG machines, and depending on the condition will have more invasive surveillance system (arterial catether, articial life support, dialysis etc...). Those patients might die from a medical error, but actually the handoff are not the problem, those are repeated, digitalized, supported and surveillance is maximal. Errors are due to the team's reactivity and knowledge in front of the severity and extremely fast time course of their condition. That is the deciding factor, of course if the doctors are exhausted, they forget things, they miss the jugular vein, they take more time cauterizing the bleed, or closing the wound, they are afraid to wake up their senior because they know he has not slept since yesterday.
On the other hand you have chronic patients, who are under light surveillance by the nurses at night, who sometime call the doctor on call who knows absolutly nothing of the patient, and is sometime not even of the speciality. If things get rough, the patient becomes "acute" and is managed by the acute team. At night for those patients, handoffs WOULD have been nice, be they were none, not because the residents did not do their 12-15 hour day but because those patients are not supposed to have handoffs to the night team, and because no doctors are paid to stay at night in all chronic services.
> Regarding your other point: > In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week,
That makes no sense. If that were the case, residents would choose to work an hour a week and easily graduate in 3-5 years. But that would make for a poor doctor, as they need a certain # hours of training.
So they do finish in 3-5 years, and make for as good doctors as US doctors, although they work more reasonable hours which is around 60 hours a week. Although I believe that is still too much to insure quality of care.
There is no logic in that, i'm not sure why you asserted that. I noted that long shifts reduce handoff errors.
Consider two scenarios: Scenario 1: 8 hour shifts: Doctor 1 hands off to Doctor 2 at end of 8 hrs Doctor 2 hands off to Doctor 3 at end of 16 hrs Doctor 3 hands off to Doctor 4 (or perhaps 1) at end of 24hrs
Each handoff is a game of telephone. In theory it should not be, but in reality it is. Details are missed, directions mangled, and risk accrued. Just like a technical design document going from a product manager to the development lead to the developer...things go wrong in the process.
Just like with tech teams where each added person creates overhead and waste from communications overhead and mis-aligned understanding of requirements, hospitals face the same issue. Unlike technology, you dont just push a fix and rebuild -- an error such as forgetting to record a symptom on the binder/EMR could mean mis-diagnosis or death. Shifting to 12-hours shifts means just two handoffs instead of three. You dont eliminate errors, but you reduce them. In some sense, it may be better to have 4 days of 12-hour shifts than 5 days of 8 hour shifts.
Of course, this is just one aspect of medical errors. There are others which may be brought on by increased shift lengths. We'd need to look at the total sum.
Regarding your other point: > In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week,
That makes no sense. If that were the case, residents would choose to work an hour a week and easily graduate in 3-5 years. But that would make for a poor doctor, as they need a certain # hours of training.