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Study links duty hour restrictions to neurosurgery complications

Michael Becker

Mistakes made by doctors, whether by misdiagnosis, prescription error or surgical error, can cause a patient to lose vital time in a fight against a serious threat to health. We expect all medical professionals to meet accepted standards of care when treating patients.

When doctors fail to provide adequate care due to an oversight caused by fatigue or distraction, patients deserve to know why. A recent study presented to the American Association of Neurological Surgeons (AANS) looked at whether limiting working hours improves quality of care.

In 2003, the Accreditation Council for Graduate Medical Education limited work hours for medical residents; resident physicians and surgeons were limited to 24-hour shifts, required to take one day off a week, and encouraged to take ten hours off between work periods. Using six years of data from over 100,000 patient admissions, the study compared rates of neurosurgery complications before and after the limitations were imposed.

Medical complications for critical neurosurgical trauma patients actually increased at teaching hospitals after the limits were instituted. The investigators found a 23 percent higher rate of complications based on disease classifications that include head and spine trauma.

Mortality rates for the same patient group remained constant, and no increase was seen at non-teaching hospitals, where residents presumably do not practice. The lead author of the study speculated on several reasons why the restrictions led to an increase, including the fact that shift limits for residents can lead to transfers of care, the strongest statistical predictor of adverse patient events that could have been prevented.

Brain injury patients almost always have critical needs when they arrive in emergency rooms. Treatment for bleeding brain injuries requires extreme caution and thorough assessment of a patient’s medical profile. Because these conditions can lead to long-term impairments and loss of cognitive function, the potential for medical malpractice must be countered by ongoing assessment of neurological techniques and protocols for continuous care.

Source: Medscape Today, “Neurosurgery Complications Up With Reduced Residency Hours,” Daniel M. Keller, May 1, 2012