“We heard from residents who were in the middle of an operative case,” Dr. Zetterman said. “A patient that had admitted in the previous 16 hours needed an emergency operation … and 16 hours came in the middle of the case, and they were told to go home. That was clearly an issue.”
The ACGME reviewed more than 1,000 studies and, in March 2016, held a two-day conference to which it invited 60 medical groups and organizations “to testify to us about what should be done in the learning/working environment,” Dr. Zetterman said. “Of all the 60 medical organizations that were there, the majority said we needed to return to 24 hours for first-year residents,” he added. “Most of them cited the impact it had on team-based care.”
Continuity of Care
Otolaryngologist Nilesh Vasan, MD, an associate professor at the University of Oklahoma Health Sciences Center, specialist in head-and-neck oncologic surgery, and program director for his hospital’s otolaryngology–head and neck surgery residency program, said that continuity of care is a major factor in weighing out the change in work hours.
First to consider is the paramount importance placed on patient care. “Following through with a patient from when you might meet them to how you make a diagnosis to subsequently initiating some sort of treatment is important, obviously, for the patient,” said Dr. Vasan. “But it’s just as important for the physician who is learning how to manage these patients.”