Long Physician Work Hours in ICUs Put Patients at Risk

Fran Lowry

January 24, 2011

January 24, 2011 (San Diego, California) — Attending physicians in pediatric, cardiovascular, and neonatal intensive care units (ICUs) are often called upon to provide direct patient care for more than 16 hours a day.

As a result, they could be putting the health of their patients, not to mention themselves, at risk, researchers reported here at the Society of Critical Care Medicine 40th Critical Care Congress.

"Attendings are increasingly being asked to provide 24-hour in-house coverage to enhance the supervision of residents and improve care quality," Katri Typpo, MD, from the University of Arizona College of Medicine in Tucson, said in a poster presentation. "We were beginning to have a concern that as duty hours for residents were decreasing, the hours for attendings were increasing."

Dr. Typpo, who began this research while she was at the Baylor College of Medicine in Houston, Texas, and her colleagues devised a questionnaire that they emailed to 688 critical care physicians across the United States.

Just over half (52%) of the surveys were returned. "We would have liked to have had a higher response rate, but at the same time, physician response rates to surveys are notoriously low because physicians tend not to respond to the emails that are sent out asking them to participate," Dr. Typpo told Medscape Medical News.

The anonymous 26-item survey asked attending physicians from fellowship programs in pediatric critical care fields how they perceived their own extended duty hour shifts.

Most of the respondents (60.5%) worked in neonatal ICUs (NICUs), 35.5% worked in pediatric ICUs (PICUs), and 14.2% worked in cardiovascular ICUs (CVICUs).

Most respondents (91.4%) said other allied health providers worked in their ICU, most commonly in the NICU (98.2%).

Attendings working in the PICU reported having the most in-house mandates for overnight call (61.9%); 38.1% of those working in the NICU and 56.0% working in the CVICU had an overnight call in-house mandate.

In all, 37.5% of respondents said they provided direct patient care after working for more than 16 consecutive hours at least once a week. These hours included work spent performing clinical and nonclinical duties.

The frequency of working extended shifts varied according to specialty, with 70.0% of CVICU, 47.3% of PICU, and 29.2% of NICU attendings reporting working at least 1 extended shift per week. The frequency of extended shifts was associated with an in-house mandate for overnight call, Dr. Typpo reported.

"Attending physicians are not immune to fatigue," she said during an interview with Medscape Medical News. "We are hoping to get this report published in a peer-reviewed publication, at least to call attention to the fact that these critical care doctors are working very long hours that put them at risk for fatigue, and may make them more prone to errors and render them less able to supervise their residents. Their long hours may end up having an adverse impact on patient care and patient safety."

Jason M. Kane, MD, from Rush University Medical Center in Chicago, Illinois, who moderated the poster session, noted that the work hours of trainees are being shortened at the expense of attending physicians, which might not be such a good idea.

"There's a disconnect between the environment we expect our trainees to work in so that they practice safe medicine and [are not] overly fatigued and therefore at higher risk of committing an error. But these safeguards are not in place at the attending provider level," he told Medscape Medical News.

Limiting the hours trainees can work is not a way to solve the problem of fatigue, he added.

"When the trainees become attendings, they're going to end up working in the same conditions. So while it's great to protect them during training, where they have work-hour restrictions, one concern is that when they get to be attending normal providers, they will not be accustomed to longer hours and may have a hard time transitioning," said Dr. Kane, who is in charge of pediatric patient safety and healthcare quality at Rush. "Why do we think that as attending providers, it is okay to protect trainees to create a safe environment but not to protect ourselves?"

Dr. Typpo and Dr. Kane have disclosed no relevant financial relationships.

Society of Critical Care Medicine (SCCM) 40th Critical Care Congress: Abstract 573. Presented January 18, 2011.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.