Response to IOM Report

Institute of Medicine Releases Resident Work Hours Recommendations

"The nation must take a hard look at its residency programs – including hours, schedules, supervision, patient caseloads and handovers – and ensure that they serve both patient and resident safety today and educational needs for tomorrow.”

(IOM Report Brief, p. 3)

 On December 2, 2008, the Institute of Medicine (IOM) released its much anticipated report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety."

Most news reports have focused on the IOM’s specific hours recommendations (e.g. a maximum shift length of 16 hours or if the extended 30 hours shift is utilized, no admitting new patients after 16 hours, and a 5-hour protected sleep period between 10 pm and 8 am, with the remaining hours for transition and educational activities).

But the 428-page report is also an exhaustive review of the ‘sleep and safety’ literature, as well as a panoramic review of graduate medical education in its entirety. Some of the other important IOM recommendations focus on workload limits, direct onsite attending supervision, safe transportation options home for  post-call residents (paid for by hospitals) and increased oversight of work hours by the federal government (Centers for Medicare and Medicaid Services) and the Joint Commission.

The IOM estimated the cost of hiring staff substitutes, other health care providers or additional residents at $1.7 billion (A huge number --  until you realize it is only about 0.4% of the Medicare budget). In the report, the IOM also called on Centers for Medicare and Medicaid Services, the Veterans Administration, Dept. of Defense, state and local governments, private insurers and teaching hospitals to “financially support the changes necessitated by the committee’s recommendations to promote patient safety and resident safety and education, with special attention to safety net hospitals.” 

CIR welcomed IOM’s report on resident work hours, but took the occasion to also call for stronger limits on extended shifts. “The recommendations in this new report are an important corroboration of our advocacy over the course of many years about the dangers of long hours to patient care and to resident well-being,” said CIR President L. Toni Lewis, MD, a geriatrician in Queens, New York. “We had hoped, however, that the Institute of Medicine would go farther in its support for the 16-hour limit.”

 Download the IOM Report's Table of Findings

 Download brief of IOM Report

 Download CIR's Position Paper on the IOM Report

 CIR Work Hours Reform Fact Sheet

>> Read CIR's Press Release in Response to the IOM Report

>> Read the press release from AHRQ, one of the co-sponsors of the study

News Articles on the IOM Report and CIR's Response

Articles that mention CIR specifically

Crain's Health Pulse -- "Resident Hours"
L.A. Times-- "Report Urges More Sleep for Medical Residents"

Other articles on the IOM Report

New York Times Editorial -- "Napping During Hospital Shifts" (12/9/08)
The Health Care Blog-- "Resident Duty Hours and Patient Safety: Did The IOM Get It Right?" (12/9/08)
New England Journal of Medicine -- "Revisiting Duty-Hour Limits -- IOM Recommendations for Patient Safety and Resident Education" (12/3/08)
N.Y. Times-- "Expert Panel Seeks Changes in Training of Medical Residents" (12/3/08)
Washington Post-- "Medical Residents Must Sleep After 16 Hours, Experts Urge" (12/3/08)
Wall Street Journal Health Blog -- "Medical Residents Need More Breaks To Prevent Errors" (12/3/08)
Scientific American-- "Medical residents need sleep, docs say" (12/3/08)
The Boston Globe -- "Report links safety to physicians' sleep" (12/3/08)
U.S. News & World Report-- "Health Buzz: Sleep Breaks for Medical Residents" (12/3/08)
USA Today -- "More sleep, not less work, for medical residents" (12/3/08)
Market Watch -- "Out on their feet -- Medical residents need more rest to prevent deadly errors: study" (12/3/08)
The Associated Press -- "Report: Young doctors still too tired for safety" (12/3/08)
United Press International -- "Doctor sleep, supervision affect patients" (12/3/08)

CIR’s Involvement in IOM’s Study of the Link Between Resident Work Hours & Patient Safety

At the behest of Congress (specifically the House Energy and Commerce Committee) and the Agency for Healthcare Research and Quality (AHRQ), the venerable Institute of Medicine has convened a Committee of experts to “synthesize current evidence on medical resident schedules and healthcare safety” and “develop strategies to enable optimization of work schedules to improve safety in the healthcare work environment.”

CIR President L. Toni Lewis, MD was asked to present at the Committee’s first public hearing in Washington DC on December 3, 2007, and CIR Exec. Vice President Nailah Thompson, DO testified during the second public hearing on March 4, 2008 in Irvine, CA.

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