Duty hours in emergency medicine: Balancing patient safety, resident wellness, and the resident training experience: A consensus response to the 2008 institute of medicine resident duty hours recommendations

Mary Jo Wagner, Stephen Wolf, Susan Promes, Doug McGee, Cheri Hobgood, Christopher Doty, Mara Ann McErlean, Alan Janssen, Rebecca Smith-Coggins, Louis Ling, Amal Mattu, Stephen Tantama, Michael Beeson, Thomas Brabson, Greg Christiansen, Brent King, Emily Luerssen, Robert Muelleman

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. Discussion: The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. Conclusion: One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.

Original languageEnglish (US)
Pages (from-to)348-355
Number of pages8
JournalJournal of Emergency Medicine
Volume39
Issue number3
DOIs
StatePublished - Sep 1 2010

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National Academies of Science, Engineering, and Medicine (U.S.) Health and Medicine Division
Emergency Medicine
Patient Safety
Hospital Emergency Service
Graduate Medical Education
Accreditation
Internship and Residency
Consultants
Fatigue
Education

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

Wagner, Mary Jo ; Wolf, Stephen ; Promes, Susan ; McGee, Doug ; Hobgood, Cheri ; Doty, Christopher ; McErlean, Mara Ann ; Janssen, Alan ; Smith-Coggins, Rebecca ; Ling, Louis ; Mattu, Amal ; Tantama, Stephen ; Beeson, Michael ; Brabson, Thomas ; Christiansen, Greg ; King, Brent ; Luerssen, Emily ; Muelleman, Robert. / Duty hours in emergency medicine : Balancing patient safety, resident wellness, and the resident training experience: A consensus response to the 2008 institute of medicine resident duty hours recommendations. In: Journal of Emergency Medicine. 2010 ; Vol. 39, No. 3. pp. 348-355.
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abstract = "Background: Representatives of emergency medicine (EM) were asked to develop a consensus report that provided a review of the past and potential future effects of duty hour requirements for EM residency training. In addition to the restrictions made in 2003 by the Accreditation Council for Graduate Medical Education, the potential effects of the 2008 Institute of Medicine (IOM) report on resident duty hours were postulated. Discussion: The elements highlighted include patient safety, resident wellness, and the resident training experience. Many of the changes and recommendations did not affect EM as significantly as other specialties. Current training standards in EM have already emphasized patient safety by requiring continuous onsite supervision of residents. Resident fatigue has been addressed with restrictions of shift lengths and limitation of consecutive days worked. Conclusion: One recommendation from the IOM was a required 5-h rest period for residents on call. Emergency department (ED) patient safety becomes an important concern with the decrease in the availability and in the patient load of a resident consultant that may result from this recommendation. Of greater concern is the already observed slower throughput time for admitted patients waiting for resident care, which will increase ED crowding and decrease patient safety in academic institutions. A balance between being overly prescriptive with duty hour restrictions and trying to improve resident wellness was recommended. Discussion is included regarding the appropriate length of EM training programs if clinical experiences were limited by new duty hour regulations. Finally, this report presents a review of the financing issues associated with any changes.",
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Wagner, MJ, Wolf, S, Promes, S, McGee, D, Hobgood, C, Doty, C, McErlean, MA, Janssen, A, Smith-Coggins, R, Ling, L, Mattu, A, Tantama, S, Beeson, M, Brabson, T, Christiansen, G, King, B, Luerssen, E & Muelleman, R 2010, 'Duty hours in emergency medicine: Balancing patient safety, resident wellness, and the resident training experience: A consensus response to the 2008 institute of medicine resident duty hours recommendations', Journal of Emergency Medicine, vol. 39, no. 3, pp. 348-355. https://doi.org/10.1016/j.jemermed.2010.05.058

Duty hours in emergency medicine : Balancing patient safety, resident wellness, and the resident training experience: A consensus response to the 2008 institute of medicine resident duty hours recommendations. / Wagner, Mary Jo; Wolf, Stephen; Promes, Susan; McGee, Doug; Hobgood, Cheri; Doty, Christopher; McErlean, Mara Ann; Janssen, Alan; Smith-Coggins, Rebecca; Ling, Louis; Mattu, Amal; Tantama, Stephen; Beeson, Michael; Brabson, Thomas; Christiansen, Greg; King, Brent; Luerssen, Emily; Muelleman, Robert.

In: Journal of Emergency Medicine, Vol. 39, No. 3, 01.09.2010, p. 348-355.

Research output: Contribution to journalArticle

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AU - Wolf, Stephen

AU - Promes, Susan

AU - McGee, Doug

AU - Hobgood, Cheri

AU - Doty, Christopher

AU - McErlean, Mara Ann

AU - Janssen, Alan

AU - Smith-Coggins, Rebecca

AU - Ling, Louis

AU - Mattu, Amal

AU - Tantama, Stephen

AU - Beeson, Michael

AU - Brabson, Thomas

AU - Christiansen, Greg

AU - King, Brent

AU - Luerssen, Emily

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