Surgery News - December 2008 - (Page 5) DECEMBER 2008 • SURGERY NEWS ACS-RAS Weighs In on 80-Hour Workweek BY JANE ANDERSON THE THE E Else vier Global Medical Ne ws ny regulatory body that is considering further restrictions to the 80-hour workweek must evaluate the potential impact on continuity of care, the burden on the health care system, and the overall quality of surgical training, according to a position statement from the American College of Surgeons’ Resident and Associate Society (ACS-RAS). Five years after implementation of the 80-hour workweek by the Accreditation Council for Graduate Medical Education (ACGME), the overall effect on the quality of patient care remains unclear. Although there have been reports of fewer medical errors and less resident fatigue, there also have been an increasing number of reports identifying problems with continuity of care, preventable communication errors, and a deterioration in the patient-resident relationship, according to Dr. Jacob Moalem of the University of Rochester (N.Y.), chair of the ACS-RAS. In anticipation of the Institute of Medicine’s new report on strategies and actions for implementing safe work schedules, to be published in February Problematic Handoffs Harm Patients policy makers further to existing 80-hour Asreductionsnewtheconsider linked workweek, a study has reports of harm to patients with problematic handoffs among residents in general surgery and internal medicine ( Jt. Comm. J. Qual. Patient Saf. 2008;34:563-70). The study, which polled 161 residents at Massachusetts General Hospital, Boston, in 2006, found that 59% of residents reported that one or more patients had been harmed during their most recent clinical rotation because of problematic handoffs. A total of 12% reported that the harm had been major, and 31% of residents said that overall quality of handoffs was fair or poor. About one-fourth of residents said that handoffs usually or always took place in a quiet setting, and 37% reported that they often or always were interrupted during handoffs. Many best-practice recommendations for handoffs were not observed, although the extent to which improved practices would reduce patient harm is not known, according to the study. Effects on patient outcomes from the 80-hour workweek most likely are mixed, the study concluded. “It seems likely that improvements to patient safety from reductions in fatigue are at least partially offset by associated changes such as increases in the number of handoffs, because handoffs, particularly when problematic, can lead to important patient information being transmitted incorrectly or not at all.” 2009, the ACS-RAS this month released a position statement indicating that it fully supports initiatives designed to improve care of surgical patients as long as the initiatives are evidence based and “founded on comprehensive study of sition statement said. The ACS-RAS posiall major contributing factors and pos- tion paper noted that, as policy makers sible ramifications.” But the statement consider changes that could restrict work noted that issues such as resident fatigue hours further, they must also take into acand inefficiencies in training programs count global implications, such as the should not be considered in isolation. trend toward extending surgical training “Clearly, measures to minimize fatigue through fellowships and the declining popand improve the efficiency ularity of surgery as a career of training are necessary,” choice for medical students. Dr. Moalem said in an inter“Lack of preparedness for view. “But to keep focusing the realities of independent on resident work hours as a practice is thought to be a mametric to measure residency jor contributing factor to more quality and as a means to than 75% of U.S. graduating improve patient safety is ingeneral surgical chief residents’ appropriate and unfounded.” choices to pursue fellowship Four years after impletraining in 2007. Further shortmentation of the regulaening work hours could only be Focusing on tions, half of nearly 600 resanticipated to augment this resident work idents who responded to an hours as a metric alarming trend,” the paper said. ACS-RAS survey said they Policy makers should examto measure felt that residents should ine the profound differences in residency quality work no more than 80 hours scope of practice among medis unfounded. per week, while half still beical and surgical specialties, and DR. MOALEM lieved that more than 80 even among the various surgihours per week were needed for optimal cal specialties, the position statement said. surgical education. Just 3% said that “ The existing regulations have already fewer than 60 hours per week would suf- successfully redirected the emphasis in fice to train surgeons. many training programs from service to “Moreover, nearly half of senior resi- education. We are young doctors who are dents believed that the 80-hour work- trying to learn and master our fields, and, week restrictions were, in and of them- as our survey clearly showed, the closer selves, a moderate or severe barrier to we get to graduating, the more we wish resident education. Clearly, surgical that our work hours were less restricted. trainees, particularly senior residents, We’re deluding ourselves if we think cutdo not uniformly agree that the 80-hour ting hours further is going to provide the workweek has been beneficial, the po- answer,” Dr. Moalem said. ■ 20/20 / 0/20 V SION O SIO SION IO SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chief, Division of Cardiothoracic Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation, SURGERY NEWS, 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960. The American College of Surgeons’ headquarters is located at 633 N. Saint Clair St., Chicago, IL 60611-3211. SURGERY NEWS (ISSN 1553-6785) is published monthly for the American College of Surgeons by Elsevier Inc., 60 B Columbia Rd., 2nd flr., Morristown, NJ 07960; 973-290-8200; fax 973-290-8250. ELSEVIER SOCIETY NEWS GROUP, A DIVISION OF INTERNATIONAL MEDICAL NEWS GROUP President, IMNG Alan J. Imhoff Director, ESNG Mark Branca Executive Director, Editorial Mary Jo M. 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Table of Contents Feed for the Digital Edition of Surgery News - December 2008 Surgery News - December 2008 Contents The 20/20 Vision: Health Reform News From the College: Nominations Thoracic: Breathing Easier Postop Management: Renal Failure Surgery News - December 2008 Surgery News - December 2008 - Contents (Page 1) Surgery News - December 2008 - Contents (Page 2) Surgery News - December 2008 - Contents (Page 3) Surgery News - December 2008 - Contents (Page 4) Surgery News - December 2008 - Contents (Page 5) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 6) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 7) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 8) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 9) Surgery News - December 2008 - News From the College: Nominations (Page 10) Surgery News - December 2008 - News From the College: Nominations (Page 11) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 12) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 13) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 14) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 15) Surgery News - December 2008 - Postop Management: Renal Failure (Page 16) Surgery News - December 2008 - Postop Management: Renal Failure (Page 17) Surgery News - December 2008 - Postop Management: Renal Failure (Page 18) Surgery News - December 2008 - Postop Management: Renal Failure (Page 19) Surgery News - December 2008 - Postop Management: Renal Failure (Page 20)
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