Correspondence

Residents' Suggestions for Reducing Medical Errors

N Engl J Med 2003; 348:2263-2264May 29, 2003

Article

To the Editor:

The Sounding Board article by Volpp and Grande (Feb. 27 issue)1 addresses the effects of hospital inefficiency on the hours worked by residents and, ultimately, on errors in care. A study we undertook to quantify the time spent by members of the house staff on nonclinical tasks highlights this issue. The time spent on several activities was measured: holding (on the telephone) for the page operator or laboratory, ordering studies, looking for charts or forms, and waiting for a computer. Over a two-week period, 14 residents prospectively recorded data on these activities. Each resident spent more than 2 hours and 26 minutes per week on these tasks. In an environment in which work hours are scrutinized, this time is critical. Furthermore, the negative psychological effect of spending prolonged periods on these tasks cannot be underestimated.

The hospital is making changes to improve the way in which members of the house staff work. A Web-based beeper system is being developed. Clerks fill out laboratory slips and call in orders for studies. Nursing stations are being reorganized. These simple measures will be effective both in increasing the amount of time available for direct patient care and in improving house-staff satisfaction.

Luci K. Leykum, M.D., M.B.A.
Columbia University College of Physicians and Surgeons, New York, NY 10032
lkl2@columbia.edu

1 References

1. 1

   Volpp KGM, Grande D. Residents' suggestions for reducing errors in teaching hospitals. N Engl J Med 2003;348:851-855
   Full Text | Web of Science | Medline

Author/Editor Response

As current and former members of medical house staffs, we are painfully aware of the excessive time spent by house staff on nonclinical activities, tasks that require a low level of skill, and attempts to overcome inefficiencies in care. As the work-hour guidelines of the Accreditation Council for Graduate Medical Education near implementation this July,1 hospitals are being forced to adjust the daily routines of house-staff members to limit their total work hours. It is our sincere hope and that of others2,3 that a careful review of the ways in which members of the house staff spend their time will be a byproduct of these efforts and will lead to a work experience for house staff that will, as Dr. Leykum states, increase “the amount of time available for direct patient care and [improve] house-staff satisfaction.” Although the house staff represents the front lines of medical care in teaching hospitals throughout the country, relatively little attention has been paid to issues related to the work environment and system design that may not only contribute to medical errors, as we argue in our article, but also affect the quality of the educational experiences and training of the next generation of physicians.

Kevin Volpp, M.D., Ph.D.
Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104
volpp70@mail.med.upenn.edu

David Grande, M.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104

3 References

1. 1

   Altman LK, Grady D. Hospital accreditor will strictly limit hours of residents. New York Times. June 13, 2002:A1.
   

2. 2

   Drazen JM, Epstein AM. Rethinking medical training -- the critical work ahead. N Engl J Med 2002;347:1271-1272
   Full Text | Web of Science | Medline

3. 3

   Weinstein DF. Duty hours for resident physicians -- tough choices for teaching hospitals. N Engl J Med 2002;347:1275-1278
   Full Text | Web of Science | Medline