Canadian Association of Internes and Residents Recommends Better Management of Resident Duty Hours

OTTAWA, April 17, 2012 /PRNewswire/ - The Canadian Association of Internes and Residents (CAIR) today released a position paper, Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours, that urges all provinces and regions in Canada to manage resident duty hours in a manner that ensures patient and resident safety and the best learning experience for residents.

CAIR recognizes the need to work towards a system that limits residents' continuous uninterrupted duty hours and allows for adequate time in between shifts to eliminate the effects of sleep deprivation.

"We understand regional complexities and the difficulties of a "one size fits all" solution but we have more and more evidence that excessive duty hours can endanger public and physician safety," said Dr. Adam Kaufman, CAIR President.

"There needs to be a national dialogue that looks at best practices for better management of resident duty hours that will enhance residents' ability to provide safe, high quality patient care, while protecting their own personal health and safety."

CAIR also recommends that the resident duty hours model must not impair residents' ability to learn and teach others. The ability to appropriately transfer care when going off duty is also critical to patient safety.

The CAIR position paper cites various studies, including a 2009 study conducted by the Institute of Medicine (IOM) that concluded "…there is extensive research that shows that fatigue is an unsafe condition that contributes to reduced wellbeing for residents and increased errors and accidents." The IOM report also states that the evidence supports the conclusion that continuous uninterrupted work beyond 16 hours compromises performance.

Recommendations:

1. Resident physicians' duty hours must be managed such that they do not in any way endanger their health or the health of patients. In particular, limits are required on the number of continuous uninterrupted hours that residents are on duty. In keeping with current evidence, CAIR urges that all provinces and regions in Canada work towards a system that limits continuous uninterrupted duty hours to 16 hours or less at a time. Additionally, the scheduling of duty hours must allow for adequate time in-between work periods to eliminate the effects of sleep deprivation. This limitation will enhance residents' ability to provide safe, high quality patient care, while protecting their own personal health and safety.
2. Resident duty hours must be such as to allow for an optimal educational experience. Specifically, trainees' duty hours must not impair their ability to learn or to train others.
3. Residents must be formally trained in handover skills, the ability to transfer care appropriately when going off duty.
4. Resident duty hours should be flexible enough to accommodate the specific context of the resident's role and the service needs on particular rotations.
5. The management of duty hours should parallel a change in the culture of medicine that addresses the effects and consequences of uninterrupted consecutive duty hours for the medical profession as a whole, including staff physicians and non-resident learners.
6. Where a violation of Federal or Provincial ethical, legislative, or legal standards has occurred, including but not limited to those related to the Canadian Charter of Rights and Freedoms, CAIR calls upon all stakeholders to address and remedy the situation as swiftly as possible.

For a complete electronic copy of Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours, visit the News & Releases section of the CAIR website: http://www.cair.ca/en/news/releases/

About CAIR:

CAIR is the national representative body of over 8,000 resident physicians in Canada. CAIR is a resident-driven organization that works collaboratively with other national health organizations to continuously improve patient care and explore new approaches to the delivery of health care. CAIR works to achieve consensus on policy and advocacy issues of a national interest. It delivers improvement to the lives of resident physicians in such areas as personal well-being, the quality of medical education and professionalism.

SOURCE The Canadian Association of Internes and Residents