Revisiting Duty-Hour Limits — IOM Recommendations for Patient Safety and Resident Education

Abstract

On December 2, about 5 years after the Accreditation Council for Graduate Medical Education (ACGME) imposed national limits on the duty hours of medical residents, the Institute of Medicine (IOM) issued a report recommending that further measures be taken to ensure that hospitals provide safer conditions for patients and trainees while maintaining rigorous teaching programs.¹ The report concludes that these new measures should be focused on alleviating fatigue and loss of sleep among trainees, increasing their supervision by more senior physicians, improving the processes by which responsibilities for patients are transferred from physicians going off duty to those coming on, and stiffening enforcement by initiating federal oversight of the regulations established by the ACGME. The report, issued by the IOM's Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Patient Safety, estimates that the cost of implementing some of the recommendations — of recruiting and paying the personnel necessary to substitute for residents — would be “in the ballpark of $1.7 billion.”