LIMIT ON HOURS FOR DOCTORS DRAWS CRITICS FROM ALL SIDES

[摘要] Four years and nearly $1 billion after New York State adopted the nation's strictest limits on the hours worked by medical residents, it is unclear whether the changes have helped or hurt patient care, doctors and hospital administrators say.In many hospital departments, the rules are simply ignored, meaning that residents are working well beyond the 80-hour-a-week limit imposed by the state and are potentially more vulnerable to exhaustion and mistakes.And where they are being followed, strict enforcement of the rules is resulting in a time-clock approach under which, critics charge, residents leave in the middle of procedures or delay tests because it is time to go home.Still others, including the author of the original regulations, argue that the rules have not gone far enough and still allow residents to continue exercising too much responsibility.While there is little statistical scientific evidence evaluating the changes, which have cost more than $840 million so far, a few studies do exist ...One study at New York Hospital suggests that a result of more frequent signouts may be confusion in ordering tests and procedures. The researchers compared the charts of 263 patients who were discharged from that hospital's general medicine service in October 1988, before the new rules took effect, with the charts of the same number of patients discharged from the same hospital a year later, four months after the shorter hours were instituted.The study found virtually no differences in the medical outcomes of the cases. But the patients treated under the new rules suffered more frequent in-hospital complications and more frequent delays of tests.

[学科分类] 儿科学