Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine
Rehab Hospitals May Harm A Third Of Patients, Report Finds
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physical therapy workouts a rehabilitation facility offers can be a crucial part of healing, doctors say. But a government study finds preventable harm — including bedsores and medication errors — occurring in some of those facilities, too.","publishDate":1469214359,"status":"inherit","parent":215784,"modified":1469214866,"caption":"The physical therapy workouts a rehabilitation facility offers can be a crucial part of healing, doctors say. But a government study finds preventable harm — including bedsores and medication errors — occurring in some of those facilities, too.","credit":"Andersen Ross/Blend Images/Getty Images","description":"The physical therapy workouts a rehabilitation facility offers can be a crucial part of healing, doctors say. But a government study finds preventable harm — including bedsores and medication errors — occurring in some of those facilities, too.","imgSizes":{"thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-400x266.jpg","width":400,"height":266,"mimeType":"image/jpeg"},"medium":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-800x533.jpg","width":800,"height":533,"mimeType":"image/jpeg"},"medium_large":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-768x511.jpg","width":768,"height":511,"mimeType":"image/jpeg"},"large":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-1440x959.jpg","width":1440,"height":959,"mimeType":"image/jpeg"},"fd-lrg":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-1920x1278.jpg","width":1920,"height":1278,"mimeType":"image/jpeg"},"fd-med":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-1180x786.jpg","width":1180,"height":786,"mimeType":"image/jpeg"},"fd-sm":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-960x639.jpg","width":960,"height":639,"mimeType":"image/jpeg"},"post-thumbnail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-672x372.jpg","width":672,"height":372,"mimeType":"image/jpeg"},"twentyfourteen-full-width":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-1038x576.jpg","width":1038,"height":576,"mimeType":"image/jpeg"},"guest-author-32":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-32x32.jpg","width":32,"height":32,"mimeType":"image/jpeg"},"guest-author-50":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-50x50.jpg","width":50,"height":50,"mimeType":"image/jpeg"},"guest-author-64":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-64x64.jpg","width":64,"height":64,"mimeType":"image/jpeg"},"guest-author-96":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-96x96.jpg","width":96,"height":96,"mimeType":"image/jpeg"},"guest-author-128":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-128x128.jpg","width":128,"height":128,"mimeType":"image/jpeg"},"detail":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-150x150.jpg","width":150,"height":150,"mimeType":"image/jpeg"},"jmtc-small-thumb":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-280x150.jpg","width":280,"height":150,"mimeType":"image/jpeg"},"kqedFullSize":{"file":"https://ww2.kqed.org/app/uploads/sites/27/2016/07/rehab_enl-c7cb79332517b8501208a4cd75fee88051f52e67-e1469214809167.jpg","width":1920,"height":1278}},"fetchFailed":false,"isLoading":false}},"audioPlayerReducer":{"postId":"stream_live"},"authorsReducer":{"byline_stateofhealth_215784":{"type":"authors","id":"byline_stateofhealth_215784","meta":{"override":true},"slug":"byline_stateofhealth_215784","name":"Marshall Allen\u003cbr />\u003ca href=\"https://www.propublica.org/article/new-report-problem-care-harms-almost-one-third-of-rehab-hospital-patients\">ProPublica\u003c/a> and \u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","isLoading":false},"adembosky":{"type":"authors","id":"3205","meta":{"index":"authors_1591205172","id":"3205","found":true},"name":"April Dembosky","firstName":"April","lastName":"Dembosky","slug":"adembosky","email":"adembosky@kqed.org","display_author_email":false,"staff_mastheads":["news","science"],"title":"KQED Health Correspondent","bio":"April Dembosky is the health correspondent for KQED News and a regular contributor to NPR. She specializes in covering altered states of mind, from postpartum depression to methamphetamine-induced psychosis to the insanity defense. Her investigative series on insurance companies sidestepping mental health laws won multiple awards, including first place in beat reporting from the national Association of Health Care Journalists. She is the recipient of numerous other prizes and fellowships, including a national Edward R. Murrow award for investigative reporting, a Society of Professional Journalists award for long-form storytelling, and a Carter Center Fellowship for Mental Health Journalism.\r\n\r\nDembosky reported and produced \u003cem>Soundtrack of Silence\u003c/em>, an audio documentary about music and memory that is currently being made into a feature film by Paramount Pictures.\r\n\r\nBefore joining KQED in 2013, Dembosky covered technology and Silicon Valley for \u003cem>The Financial Times of London,\u003c/em> and contributed business and arts stories to \u003cem>Marketplace \u003c/em>and \u003cem>The New York Times.\u003c/em> She got her undergraduate degree in philosophy from Smith College and her master's in journalism from the University of California, Berkeley. She is a classically trained violinist and proud alum of the first symphony orchestra at Burning Man.","avatar":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twitter":"adembosky","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"arts","roles":["author"]},{"site":"news","roles":["editor"]},{"site":"futureofyou","roles":["author"]},{"site":"stateofhealth","roles":["editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"April Dembosky | KQED","description":"KQED Health Correspondent","ogImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/ef92999be4ceb9ea60701e7dc276f813?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/adembosky"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_360674":{"type":"posts","id":"stateofhealth_360674","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"360674","score":null,"sort":[1501803148000]},"guestAuthors":[],"slug":"is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","publishDate":1501803148,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>[audio src=\"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg\" Title=\"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine\" program=\"The California Report\"]\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n","blocks":[],"excerpt":"Medical education council scraps old rules that limited beginner doctors to 16-hour shifts. This summer, the 28-hour max is back.","status":"publish","parent":0,"modified":1501897616,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1009},"headData":{"title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine | KQED","description":"Medical education council scraps old rules that limited beginner doctors to 16-hour shifts. This summer, the 28-hour max is back.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","datePublished":"2017-08-03T23:32:28.000Z","dateModified":"2017-08-05T01:46:56.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"360674 https://ww2.kqed.org/stateofhealth/?p=360674","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/08/03/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine/","disqusTitle":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","path":"/stateofhealth/360674/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>It was 1 am at San Francisco General Hospital. Saturday. The ambulances were rolling in one after another. Resident doctor Josie Valenzuela was near the end of her shift, trying to stay awake.\u003c/p>\n\u003cp>“I was really tired. And my back hurt a lot,” she remembers. “My mind was wandering all over the place.”\u003c/p>\n\u003cp>She was caring for a heroin addict, cutting an abscess open on her leg to drain infection. Then her pager went off. Another ambulance was coming in and this would have to wait for later.\u003c/p>\n\u003cp>“So I went to put the scalpel in some sterile towels for when I could come back,” Valenzuela says, “and I cut my left index finger.”\u003c/p>\n\u003cp>The patient had HIV and hepatitis C.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I knew this was a bad exposure, and that all of the blood and pus that was on that scalpel was now touching my bloodstream,” she says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"http:www.kqed.org/.stream/anon/radio//2017/08/28hourworkdayDembosky.mp3","image":"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-ultrasound-768x432.jpg","title":"Is it OK for First-Year Doctors to Work 28 Hours in a Row? New Rule Says It's Fine","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Valenzuela would have to take anti-viral medications that would make her nauseated for weeks. And she’d have to explain to her husband that she may have contracted a life-long disease.\u003c/p>\n\u003cp>“We were going to start trying to have kids soon,” she says, choking up, “and so that would make it complicated for us.”\u003c/p>\n\u003cp>That’s what she was thinking about when she finally left the hospital at 4 in the morning.\u003c/p>\n\u003cp>“I found my car and I was backing out,” she says. “And I mixed up the gas and the brake. I've never done that before, but I backed right into a concrete pole.”\u003c/p>\n\u003cp>Mistakes like these led medical experts at the Institute of Medicine to issue a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/23616719\" target=\"_blank\" rel=\"noopener noreferrer\">recommendation \u003c/a>in 2009 that residents' work shifts be capped at 16 hours. Until then, they were allowed to work up to 28 hours. After a year-long review of the scientific literature, the Institute concluded that human performance begins to decline after 16 hours, and the risk of medical errors and car accidents goes up.\u003c/p>\n\u003cp>So, in 2011, the \u003ca href=\"http://www.acgme.org/\" target=\"_blank\" rel=\"noopener noreferrer\">Accreditation Council for Graduate Medical Education\u003c/a> made a rule, saying first-year doctors could only work a maximum of 16 hours per shift.\u003c/p>\n\u003cp>But this year, the council reversed itself, and starting this summer, new doctors can again work up to 28 hours in a row.\u003c/p>\n\u003cp>“I think the majority of patients in the United States expect that their physician will be available to them whether it's daytime, nighttime, Saturday or Sunday,” says Dr. Rowen Zetterman, co-chair of the task force that reviewed and changed the rule.\u003c/p>\n\u003cfigure id=\"attachment_360682\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-360682\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/08/Josie-Valenzuela-microscope-800x450.jpg\" alt=\"\" width=\"800\" height=\"450\">\u003cfigcaption class=\"wp-caption-text\">Josie Valenzuela looks through a slit lamp at work. The microscope is for examining the eye. \u003ccite>(Georgie Baumann/University of Arizona)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Patient and resident groups wanted to keep the 16-hour rule, Zetterman says. But senior doctors argued that long hours come with the profession. They complained that the shift limits cut into the time they had for teaching in the hospital, compromising the educational integrity of the residency.\u003c/p>\n\u003cp>“You ask residents a question and they'll say, ‘’I'm just covering, I don't know those things.’ That drives the more senior physicians batty,” says Adams Dudley, a pulmonologist and professor at UCSF School of Medicine. “The perception is they don't know what they're doing as well because they spend less time at the hospital.”\u003c/p>\n\u003cp>Physicians grouse that residents don’t seem as invested in the work when shift limits are in effect, he says, because they’re more focused on handing off their patients to others, rather then seeing them through the cycle of illness.\u003c/p>\n\u003cp>“Because they leave, they don't see the evolution of things, and they don't know the patients as well,” Dudley says. “If you're told you must pay attention to leaving, you have to detach yourself from the patient.”\u003c/p>\n\u003cp>Surgical residents complained about this, too.\u003c/p>\n\u003cp>“They would be in the middle of an operation that they felt like they were learning from, and they would hit the end of their 16 hours and be told that they had to leave the operation and go home,” Zetterman says.\u003c/p>\n\u003cp>This hurt morale on the health care team, he says, as other doctors watched first-year residents clock out when they had to stay, and raised patient-safety concerns.\u003c/p>\n\u003cp>“Let's say your copilot kept coming and going throughout the flight and, then was gone. Didn't come back for the remainder that flight,” Zetterman says. “It seems to me that would be disruptive.”\u003c/p>\n\u003cp>It’s unclear what’s riskier for patients: more frequent hand-offs between doctors, or doctors that are just exhausted. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/26054323\" target=\"_blank\" rel=\"noopener noreferrer\">Most studies \u003c/a>show little or no change in patient outcomes after shift limits were put in place, suggesting mistakes and miscommunications that resulted from transitions in care offset any gains made from reducing doctor fatigue.\u003c/p>\n\u003cp>If that's the case, Dr. Josie Valenzuela believes there should be more focus on residents’ well-being, in addition to patients. And while the shift limit was extended to 28 hours in the regulatory, other rules require residency programs to provide more support for residents who feel burned out, stressed, or depressed, including \u003ca href=\"https://ww2.kqed.org/news/2017/07/05/physicians-are-human-beings-new-rules-aim-to-battle-burnout-in-medical-residencies/\" target=\"_blank\" rel=\"noopener noreferrer\">24/7 access\u003c/a> to a mental health professional.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Valenzuela is in her last year of residency now. She says she was lucky after that accidental cut. After nearly a year of periodic checks, she's been officially declared negative for HIV and hepatitis C. Next year, she and her husband plan to have a baby.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/360674/is-it-ok-for-first-year-doctors-to-work-28-hours-in-a-row-new-rule-says-its-fine","authors":["3205"],"categories":["stateofhealth_14"],"tags":["stateofhealth_2808","stateofhealth_2616","stateofhealth_2828","stateofhealth_2519","stateofhealth_3146"],"featImg":"stateofhealth_360675","label":"stateofhealth"},"stateofhealth_215784":{"type":"posts","id":"stateofhealth_215784","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"215784","score":null,"sort":[1469214894000]},"guestAuthors":[],"slug":"rehab-hospitals-may-harm-a-third-of-patients-report-finds","title":"Rehab Hospitals May Harm A Third Of Patients, Report Finds","publishDate":1469214894,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.\u003c/p>\n\u003cp>In a government report \u003ca href=\"https://www.documentcloud.org/documents/2995032-HHS-OIG-Adverse-Events-RFs.html\" target=\"_blank\">published\u003c/a> Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.\u003c/p>\n\u003cp>Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.\u003c/p>\n\u003cp>\"This is the latest study over a long time period now that says we still have high rates of harm,\" says \u003ca href=\"https://www.amia.org/about-amia/leadership/acmi-fellow/david-c-classen-md-ms-facmi\" target=\"_blank\">Dr. David Classen\u003c/a>, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.\u003c/p>\n\u003cp>\"We're fooling ourselves if we say we have made improvement,\" Classen says. \"If the first rule of health care is 'Do no harm,' then we're failing.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The oversight study, from the \u003ca href=\"https://oig.hhs.gov/\" target=\"_blank\">office of the inspector general\u003c/a> of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.\u003c/p>\n\u003cp>Still, the findings echoed those of previous studies that found that more than a quarter of patients in \u003ca href=\"https://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf\" target=\"_blank\">hospitals\u003c/a> and a third in \u003ca href=\"https://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment\" target=\"_blank\">skilled nursing facilities\u003c/a> suffered harm related to their care.\u003c/p>\n\u003cp>\"It's important to acknowledge that harm can occur in any type of inpatient setting,\" says Amy Ashcraft, a team leader for the rehabilitation hospital study. \"This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur.\"\u003c/p>\n\u003cp>For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.\u003c/p>\n\u003cp>Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.\u003c/p>\n\u003cp>The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.\u003c/p>\n\u003cp>That high number indicates there's lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.\u003c/p>\n\u003cp>\"We know a lot about preventing medication errors,\" Thomas says.\u003c/p>\n\u003cp>An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient's death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.\u003c/p>\n\u003cp>\"It is a domino effect for any person who has had an adverse event,\" says McGiffert, who was not involved in the study.\u003c/p>\n\u003cp>The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.\u003c/p>\n\u003cp>Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its\u003c/em> \u003ca href=\"https://www.propublica.org/getinvolved/item/have-you-been-harmed-in-a-medical-facility-share-your-story\" target=\"_blank\">Patient Harm Questionnaire\u003c/a> \u003cem>and\u003c/em> \u003ca href=\"https://www.facebook.com/groups/patientharm/\" target=\"_blank\">Patient Safety Facebook Group\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Rehab+Hospitals+May+Harm+A+Third+Of+Patients%2C+Report+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Patients are sent to rehab facilities to recover from a medical crisis or surgery, but too often suffer additional harm once they get there.","status":"publish","parent":0,"modified":1469214953,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":20,"wordCount":703},"headData":{"title":"Rehab Hospitals May Harm A Third Of Patients, Report Finds | KQED","description":"Patients are sent to rehab facilities to recover from a medical crisis or surgery, but too often suffer additional harm once they get there.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Rehab Hospitals May Harm A Third Of Patients, Report Finds","datePublished":"2016-07-22T19:14:54.000Z","dateModified":"2016-07-22T19:15:53.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"215784 http://ww2.kqed.org/stateofhealth/?p=215784","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/07/22/rehab-hospitals-may-harm-a-third-of-patients-report-finds/","disqusTitle":"Rehab Hospitals May Harm A Third Of Patients, Report Finds","nprImageCredit":"Andersen Ross","nprByline":"Marshall Allen\u003cbr />\u003ca href=\"https://www.propublica.org/article/new-report-problem-care-harms-almost-one-third-of-rehab-hospital-patients\">ProPublica\u003c/a> and \u003ca href=\"http://www.npr.org/sections/health-shots/\">NPR Shots\u003c/a>","nprImageAgency":"Blend Images/Getty Images","nprStoryId":"486756178","nprApiLink":"http://api.npr.org/query?id=486756178&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2016/07/21/486756178/rehab-hospitals-may-harm-a-third-of-patients-report-finds?ft=nprml&f=486756178","nprRetrievedStory":"1","nprPubDate":"Thu, 21 Jul 2016 11:35:00 -0400","nprStoryDate":"Thu, 21 Jul 2016 00:02:00 -0400","nprLastModifiedDate":"Thu, 21 Jul 2016 12:25:33 -0400","path":"/stateofhealth/215784/rehab-hospitals-may-harm-a-third-of-patients-report-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Patients may go to rehabilitation hospitals to recover from a stroke, injury or recent surgery. But sometimes the care makes things worse.\u003c/p>\n\u003cp>In a government report \u003ca href=\"https://www.documentcloud.org/documents/2995032-HHS-OIG-Adverse-Events-RFs.html\" target=\"_blank\">published\u003c/a> Thursday, 29 percent of patients in rehab facilities suffered a medication error, bedsore, infection or some other type of harm as a result of the care they received.\u003c/p>\n\u003cp>Doctors who reviewed Medicare cases from a broad sampling of rehab facilities say that almost half of the 158 incidents they spotted among 417 patients were clearly or likely preventable.\u003c/p>\n\u003cp>\"This is the latest study over a long time period now that says we still have high rates of harm,\" says \u003ca href=\"https://www.amia.org/about-amia/leadership/acmi-fellow/david-c-classen-md-ms-facmi\" target=\"_blank\">Dr. David Classen\u003c/a>, an infectious disease specialist at the University of Utah School of Medicine who developed the analytic tool used in the report to identify the harm to patients.\u003c/p>\n\u003cp>\"We're fooling ourselves if we say we have made improvement,\" Classen says. \"If the first rule of health care is 'Do no harm,' then we're failing.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The oversight study, from the \u003ca href=\"https://oig.hhs.gov/\" target=\"_blank\">office of the inspector general\u003c/a> of the U.S. Department of Health and Human Services, focused on rehabilitation facilities that were not associated with hospitals. Rehab facilities generally require that patients be able to undergo at least three hours of physical and occupational therapy per day, five days a week. Patients at these facilities are presumed to be healthier than patients in a more typical hospital or a nursing home.\u003c/p>\n\u003cp>Still, the findings echoed those of previous studies that found that more than a quarter of patients in \u003ca href=\"https://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf\" target=\"_blank\">hospitals\u003c/a> and a third in \u003ca href=\"https://www.propublica.org/article/one-third-of-skilled-nursing-patients-harmed-in-treatment\" target=\"_blank\">skilled nursing facilities\u003c/a> suffered harm related to their care.\u003c/p>\n\u003cp>\"It's important to acknowledge that harm can occur in any type of inpatient setting,\" says Amy Ashcraft, a team leader for the rehabilitation hospital study. \"This is one of the settings that's most likely to be underestimated in terms of what type of harm can occur.\"\u003c/p>\n\u003cp>For the purposes of the study, doctors and nurses identified harm by reviewing the medical records of 417 randomly selected Medicare patients who stayed in U.S. rehabilitation facilities in March 2012. The events they identified varied in severity, ranging from a temporary injury to something that required a longer stay at the facility or that led to permanent disability or death.\u003c/p>\n\u003cp>Almost a quarter of the harmed patients had to be admitted to an acute care hospital, at a cost of about $7.7 million for the month analyzed, the study shows.\u003c/p>\n\u003cp>The physicians who reviewed the cases for the OIG say substandard treatment, inadequate monitoring, and failure to provide needed care caused most of the harm. Almost half the cases, 46 percent, were related to medication errors and included bleeding from gastric ulcers due to blood thinners and a loss of consciousness linked to narcotic painkillers.\u003c/p>\n\u003cp>That high number indicates there's lots of room for improvement, says Dr. Eric Thomas, director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety.\u003c/p>\n\u003cp>\"We know a lot about preventing medication errors,\" Thomas says.\u003c/p>\n\u003cp>An additional 40 percent of the cases in which patients were harmed were traced to lapses in routine monitoring that led to bedsores, constipation or falls. These problems almost never contributed to a patient's death but could mean extra days or weeks of recovery, a loss of independence or permanent disability, says Lisa McGiffert, director of the Consumers Union Safe Patient Project.\u003c/p>\n\u003cp>\"It is a domino effect for any person who has had an adverse event,\" says McGiffert, who was not involved in the study.\u003c/p>\n\u003cp>The inspector general is recommending that Medicare and the Agency for Healthcare Research and Quality work together to reduce harm to patients by creating a list of adverse events that occur in rehab hospitals. In their responses to the report, the agencies have pledged to follow that suggestion.\u003c/p>\n\u003cp>Officials from the American Medical Rehabilitation Providers Association, the trade group that represents rehab facilities, say they have not yet seen the report and decline to comment for now.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>ProPublica is interested in hearing from patients who have been harmed while undergoing medical care, through its\u003c/em> \u003ca href=\"https://www.propublica.org/getinvolved/item/have-you-been-harmed-in-a-medical-facility-share-your-story\" target=\"_blank\">Patient Harm Questionnaire\u003c/a> \u003cem>and\u003c/em> \u003ca href=\"https://www.facebook.com/groups/patientharm/\" target=\"_blank\">Patient Safety Facebook Group\u003c/a>.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2016 ProPublica. To see more, visit \u003ca>ProPublica\u003c/a>.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Rehab+Hospitals+May+Harm+A+Third+Of+Patients%2C+Report+Finds&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/215784/rehab-hospitals-may-harm-a-third-of-patients-report-finds","authors":["byline_stateofhealth_215784"],"categories":["stateofhealth_11"],"tags":["stateofhealth_2828","stateofhealth_2829","stateofhealth_2827"],"featImg":"stateofhealth_215785","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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