24hr call shifts

nrw350 · Nov 26, 2002

I would think that 24hr shifts in that area would be too dangerous due to fatigue and exhaustion?

Nick

Roland · Nov 27, 2002

LESS common among CRNA's than among medical schools residents. Which brings me to the issue of tort liability. How do hospitals get away with these types of shifts in the wake of so many malpractice happy attoneys? Why wouldn't being on duty over a certain amount of hours be prima facia evidence of malpractice when things go bad? I can remember having to take a defensive driving class years ago and being lectured upon how that if you drive with less than six hours sleep it's the same as being .10 BAC. Now, if its not okay to operate a vehicle while sleep deprived how can it be acceptable to have patient's lives in your hands during critical procedures?

I expect that Tenesma is going to advise me of how critical this sort of experience is to creating competent practitioners. However, even if we agree that such experience has its advantages the question still remains as to whether or not these ends justify the greater risks incurred by patients. In the Navy except during WARTIME no one typically is on shift longer than twelve hours (there are exceptions during exclusively TRAINING conditions such as during hell week of BUDS).

Tenesma · Nov 27, 2002

well since my name was mentioned by roland.... i might as well throw in my 2 cents...

24 hour shifts... to be quite honest is a definite improvement over my old 36 to 40 hour shifts in the past... i remember during internship not going home for 3 or 4 days straight with a total of 4 hours sleep... boy those were the days :)

regardless... pilots are not allowed to fly planes for longer than 8 hours straight, so it would only seem appropriate if the same applied to medical professionals... curiously, the argument against that is that pilots only have a copilot as backup, whereas in a medical facility your backup is a lot more extensive.

what the 24 hours provide: you learn to function under fatigue conditions, you get to learn how to manage patients with less people around to help (night-time) and you get to manage some real sick middle-of-the-night disasters... all wonderful learning experiences.... and you also accumulate your clinical knowledge base a lot faster than if you were to break that 24 hours into 3 different days of 8 hours... who would want to do a 6 year anesthesia residency program to obtain the same amount of cases, etc (i don't know by how much longer CRNA training would be extended).

as far as liability goes, i think any good lawyer could make the case that after 18 hours of straight work anybody's judgement will be impaired... but at the same time, i have to be honest: you definitely build up a tolerance for those long shifts...