Excessive Work Hours of Physicians in Training in El Salvador: Putting Patients at Risk

摘要

Recent studies involving physicians in training have shown that excessive work hours are associated with an increased rate of medical errors and adverse events. Studies of surgical residents found that they made up to twice the number of technical errors in the performance of simulated laparoscopic surgical skills after working overnight than after a night of sleep [1,2]. A landmark study of interns working in an intensive care unit found that they made substantially more serious medical errors when they worked frequent shifts of 24 hours or more than when they worked shorter shifts [3]. A national prospective study of interns in the United States found that extended-duration work shifts (defined as at least 24 continuous hours at work) were associated with an increased risk of significant medical errors, adverse events, and attentional failures [4]. According to the Institute of Medicine [5], preventable medical errors are responsible for the death of up to 98,000 people in the US every year, accounting for a higher mortality than car accidents, breast cancer, or AIDS. Although it is not known how many of these medical errors were due to fatigue, it is now acknowledged that fatigue associated with the excessive work hours of physicians in training is an important cause of medical errors. Hence, the issue of excessive work hours of physicians in training is becoming a public health priority in many countries worldwide.