Cutting junior doctor’s hours does not compromise patients’ safety and could dramatically reduce mistakes, according to research by the University of Warwick Medical School.

The intervention study, the first in the UK and Europe, looked at the impact of a 48 hour EWTD compliant rota on medical errors and patients' safety over a 12 week period. It found that those on shorter rotas benefited from longer sleep time - 7.26 hours per day compared with 6.75 hours a day on a normal rota – and produced a third (32.7%) fewer medical errors.

"The study not only showed that patients' safety was not compromised during the 48h-week rota, but if anything we detected a 30% reduction in non-serious medical errors during the experimental rota compared to the traditional rota," said Professor Francesco Cappuccio, lead researcher in the study. 

"These results provide some evidence-base to reassure all of us that the widely held belief that reducing the hours would lead to risks to patients is not necessarily true."

The project, funded by the NHS National Workforce Projects, observed 19 junior doctors at the University Hospitals Coventry & Warwickshire NHS Trust over a 12-week period. Nine were studied while working less than 48 hours per week and 10 were on traditional schedule of an average of 56 hours a week.

Sleep and care continuity

However some, including Hugh Cairns, Consultant Nephrologist at King's College Hospital, argue that improved sleep may have been the more influential factor:

"The Warwick study has a number of limitations as the shorter hour rota, besides involving shorter hours, was designed to produce a more effective sleep pattern and also provided the junior doctors doing that rota with advice on sleep hygiene and managing tiredness," he said.

"Therefore the conclusion from the study is perhaps not that shorter hours are necessarily better but that well designed rotas combined with appropriate education of staff will improve sleep and reduce certain sorts of medical errors."

There was also a perceived reduction in overall junior doctor cover by other hospital staff in the study on the shorter rota - something that continues to concern the Royal College of Surgeons.

"Feedback from both consultants and trainees has indicated that reduced working hours in surgery will have a detrimental effect on providing continuity of care, with particular anxiety over the need for multiple handover sessions between changing teams of junior doctors," said John Black, President, Royal College of Surgeons.

Issues of compliance

The study comes as the BMA released data this month that shows almost half (46%) of junior doctors are still working hours in excess of the new 48 hour working week which will be enforced from August 2009.

"The new figures on junior doctor working hours are worrying. Trusts have had many years to prepare for the introduction of the European Working Time Directive and it is of concern that so much remains to be done to bring junior doctors working hours down in line with the rest of the medical profession," said Mr Ram Moorthy, Chairman of the BMA's Juniors Doctors Committee.

www.warwick.ac.uk

www.rcseng.ac.uk

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