“Changing duty hours means changing everything,” from work flow and coverage strategies to transfer-of-care techniques and the “very fundamentals of how patients are treated” and what residents are responsible for, said Dr. Ethan Fried, director of graduate medical education at St. Luke's-Roosevelt Hospital Center in New York.
Hospitals in New York state have been dealing with work hour limits and supervision requirements since 1988, several years after the death of Libby Zion in a teaching hospital spurred the state to take action.
Changes made at Dr. Fried's hospital mean that a patient may be admitted by one team of residents, treated by another, and discharged by yet another. “It's up to educators to help residents integrate these experiences,” he said. “I don't know whether I can.”