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OM in the News: Quality Problems in Hospital Internship Training

April 5, 2013

hospital qualityGiving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research, says Time (March 26, 2013), shows  that’s not the case. Since 2011, new regulations restricting the number of continuous hours 1st-year residents spend on call cut the time that trainees spend at the hospital from 24 to 16 hours. Excessively long shifts were leading to fatigue and stress that  hampered not just the learning process, but the care these doctors provided.

But in a large new study that compared interns serving before the  2011 work-hour limit was implemented with interns working after the new rule, the number of medical  errors the post-2011 doctors reported was higher than those among previous trainees. In the year before the new duty-hour rules took effect, 19.9% of the interns reported committing an error that harmed a patient, but this percentage went up to 23.3% after the new rules went into effect.

How could fewer hours lead to more errors? For one, interns were still expected to accomplish the same amount that previous classes had, so they had less time to complete their duties. This “work compression” increases the risk of errors or mistakes if residents don’t have as much time to make and recheck patient-care decisions. And the reduction in work hours has not been accompanied, for the most part, by increase in funding to off-load the work, so current interns have about 20 fewer hours/week  to complete the same work.  Another source of errors came as one intern going off duty handed his cases to another. With fewer work hours, the number of handoffs has increased from an average of 3 during a shift to as many as 9.  Anytime a doctor passes on care of a patient to another physician, there is a chance for error in communicating complications, allergies, or other aspects of the patient’s health.

Discussion questions:

1. Relate this issue to the 10 determinants of service quality in Table 6.5 in the text.

2. What can be done from an OM perspective to improve the intern situation?

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