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December 4, 2013

Does Improving Handoffs Reduce Medical Error Rates?

Author Affiliations
  • 1Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
JAMA. 2013;310(21):2255-2256. doi:10.1001/jama.2013.281827

In 1965, the American Medical Association declared that “An intern’s duties and responsibilities are not discharged on a ‘nine-to-five’ basis. While an acceptable internship provides for a reasonable amount of free time, [the intern’s] thought for and contact with his patients should be on a ‘round-the-clock’ basis.”1 In the intervening 45 years, the advent of the hospitalist movement fragmented inpatient and outpatient care, payment by diagnosis reduced length of stay, hospitalization rates per capita increased by 15%,2 and more than 1000 new drug applications were approved.3 In short, inpatient care is now more fragmented, more frantic, and more complicated than in the 1960s. At the same time, the science of sleep and cognition matured enough to make the risks of working while fatigued unequivocally clear, and the influx of women into medical training made it increasingly difficult to sustain the fiction that house staff have no obligations outside the hospital. The medical establishment reacted accordingly by restricting work hours of house staff. Thus, in 2013 not only is the “round the clock” internship a relic of the past, but in Europe internships are approaching the “nine to five” standard, with work-hours restricted to 48 hours a week.4