White paper on work hours reform catches industry attention

Physician leaders in medicine and patient safety released a white paper today in the journal Nature and Science of Sleep calling for reform of resident physician training to improve medical education and protect patients from fatigue-related medical errors. 

The report is causing a stir in the healthcare community, and both industry “required-reading” media outlets and consumer press organizations such as Kaiser Health News, The Wall Street Journal, Reuters, Healthwatch, Fox News, HealthLeaders Media, and Political Pulse are covering the publication.

The author team is led by such notable experts in sleep science and patient safety as Lucian Leape, MD, Harvard School of Public Health; Christopher P. Landrigan, MD, MPH, Brigham and Women’s Hospital; and Charles A. Czeisler, PhD, MD, Brigham and Women’s Hospital. CIR’s non-profit Policy and Education Initiative sponsored the conference.

» Learn more about the report.

WHITE PAPER: Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision and safety

Twenty-six of the nation’s leaders in medicine, health care, patient safety and research released a white paper today with recommendations for improving patient safety and residency training and well-being. The report, published by the journal Nature and Science of Sleep, called for sweeping changes in the design, supervision and financing of U.S. hospital residency care programs to protect patients from serious, preventable medical errors, and end dangerously long work hours for physicians in training. The authors suggest that all medical residents should work no more than 16 hours without sleep, and that Medicare physician training funds to hospitals should be tied to work-hour compliance. 

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Disclosure shown to benefit patients and physicians in malpractice situations

Chris Stern-Hyman, JD leads residents in a seminar on medical malpracticeMost residents didn’t learn much about medical malpractice in med school. It likely hasn’t been taught in Grand Rounds, and it’s not often covered on the wards. If residents did receive any information, the message might have been “Don’t talk about it.” Often they don’t even know that they can be sued as a resident. Residents do know that this vast, abstract system is broken, but they’re not sure what the solution is.

PEI sponsored medical malpractice seminars, led by Chris Stern-Hyman, JD, to educate residents on alternative dispute resolutions, specifically the policy of post-adverse event disclosure, apology, and mediation. In conjunction with an early offer of fair compensation where justified, research has shown that this policy can reduce the expenses for all parties involved, and enable the hospital to identify and correct underlying systemic problems, while providing a much quicker financial resolution and avoiding the emotional difficulties for both patients and doctors caused by years of litigation. For example, the University of Michigan Health System noted that, in adopting a policy of disclosure and apology, its open medical malpractice claims dropped from 262 in 2001 to 83 in 2007 and reserves for claims were cut from $72 million to less than $20 million.[1] The government is getting behind this too; the Affordable Care Act has appropriated $50 million for a five-year period for states that can demonstrate productive alternatives to the litigation system.[2]

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PEI Hosts AMSA's Health Equity Leadership Institute

The CIR Policy and Education Initiative co-sponsored the three-day 2011 Health Equity Leadership Institute conference this past April at CIR’s national office in New York. Approximately 30 student leaders took part in discussion groups and skills-based training sessions focused on patient-centered care and cultural sensitivity. Among the featured presenters were organizers from CIR and Bronx Health REACH, a coalition of organizations committed to eliminating racial and ethnic health disparities. They described their efforts to connect resident physicians’ training in Bronx teaching hospitals with the health needs of their patient communities, which are among the unhealthiest in the country. CIR’s Healthy Bronx initiative exemplified for participants how by working in the community, physicians can empower their patients to overcome both widespread health challenges and the social realities—poverty, malnutrition and poor access to health coverage—which serve as their basis.

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Resident work hours redesign

Teaching hospitals and residency programs across the country are scrambling to implement the new ACGME resident work hours rules that will take effect on July 1, 2011. To help provide residents the tools to participate in discussions at their hospitals, CIR created a tool kit that draws on best practices from innovative programs that have fully redesigned their schedules.

Experience shows that when residents participate in schedule redesign, all residents benefit from shorter hours, better training and a safer work environment. 

The Work Smart Toolkit is a comprehensive document detailing tips and resources for residency program redesign and case studies of innovative programs that have already made the successful transition.

» Download the Work Smart Toolkit