“There are many centers that culturally, fundamentally, don’t believe in this change,” said Christopher Landrigan, an associate professor of medicine and pediatrics at Harvard Medical School and a member of the Harvard Work Hours Health and Safety Group at Boston’s Brigham and Women’s Hospital.
Landrigan headed a landmark 2004 study that is largely credited with — or blamed for — the 16-hour rule. His team found that interns working a 24-hour shift in the intensive care unit of Brigham and Women’s committed 36 percent more serious errors than when they worked 16 hours. Among the mistakes: giving a patient a drug to which he had a known allergy, prescribing overdoses of medications by incorrectly calculating dosages and inserting a chest tube on the wrong side.
“Many people of my generation are deeply invested in” the system in which they trained, when 120-hour workweeks were common, said Landrigan, who is 43.
Shorter shifts are also occurring at a time of increased hospital admissions at major teaching hospitals, coupled with briefer stays and sicker patients. “The way the system works today, you’re getting a huge volume of patients coming in, and it makes for a much more frenetic environment,” Sen said.
Interns, who earn about $35,000 to $50,000 annually, have long provided cheap labor for teaching hospitals, performing many tasks that don’t require a medical degree. They chase test results, complete mounds of documentation, deal with insurance companies and for years covered hospital wards at night with little supervision. One study estimated that limiting intern shifts to 16 hours would cost $177 million to $982 million annually, an expense teaching hospitals say they can’t afford.
But some places have embraced the change.
Vanderbilt University Hospital’s internal medicine program spent nearly a year revamping its internship, creating day and night teams that work 13 hours, with an overlap to improve patient handoffs. A pair of recent studies found that the new system was working well: Despite increased handoffs, researchers found minimal impact on the efficiency and quality of care that patients received, as measured by readmissions, ICU transfers and other data.