Hospitals in New York state have been dealing with work hour limits and supervision requirements since 1988, several years after the death of Libby Zion in a teaching hospital spurred the state to take action.
Changes made at Dr. Fried's hospital mean that a patient may now be admitted by one team of residents, treated by another, and discharged by yet another. “And it's up to educators to help residents integrate these experiences,” he said. “I [still] don't know whether I can.”
In Europe, the IOM committee was reminded, physicians and other health care workers are prohibited from working more than 13 hours straight or more than 48–56 hours per week.
Different methods of graduate medical education financing and other health system differences make comparisons difficult, however. Here in the United States, Dr. Fried said, “with duty hour restrictions coming at the same time as patient volumes have increased, as acuity (of illness) in teaching hospitals has increased, and even as our treatments have become higher-stakes treatments, we have the perfect storm.”