✚ A tale of two nights—the problem with resident work hours

A few weeks ago, I worked Friday/Saturday overnight shifts on the general inpatient pediatrics team. The two nights were complete opposites.

On Friday night, when I arrived at the hospital my team was just finishing up 3 admissions. I immediately went to work helping out with those admissions. We admitted 4 more patients overnight. We were steadily busy throughout the night without much of a break.

On Saturday night, we had zero admissions [1]. I received a couple of pages regarding minor issues. I relaxed most of the night and got several hours of good sleep.

Due to the resident work hour restrictions, I had to be out of the hospital by noon following each of those nights, regardless of how hard I worked or how much sleep I got.

We restrict resident work hours because work hours are easy to count [2]. They are not indicative of what we are really trying to avoid—fatigue. Unfortunately, fatigue is very difficult to measure and even more difficult to predict. Until we make progress in this area, we will continue to see minimal impact of work hour restrictions on patient safety.

  1. According to the senior residents, busy Friday nights followed by slow Saturday nights are quite common. Their speculation—people take their children to the doctor’s office on Friday before the weekend, the doctor doesn’t feel comfortable with the patient and can’t see them in follow-up the next day, so they send them for admission. On Saturdays, parents tend to try to wait it out until Monday to see their regular doctor. I have no empiric or even much anecdotal evidence to support this theory.  ↩

  2. While easy to count, work hours are by no means an accurate measure. All residency programs I am aware of rely on self-report of work hours.  ↩