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European work laws risk patient safety

Juniors won’t get enough time to learn their job with 48-hour working week

Lisa Hitchen

Friday, 04 April 2008

Junior doctors will miss out on training opportunities and patients will lose continuity of care under the shift to the 48-hour week in 2009, says the Royal College of Physicians lead on the European Working Time Directive (EWTD).

Professor Roy Pounder writes his concerns in this month’s Clinical Medicine. The shift from the current practice of a 56-hour week to a 48-hour week on 1 August 2009 will have grave implications for everyone, he writes.

As most juniors work the majority of their time during the day Monday to Friday, this will be when most savings in hours will have to be made, he says. This is also the time when most training is done.

"One less day in hospital every week means it will be virtually impossible for a junior doctor to watch (and learn about) the progress of an illness. This is not just a vital educational experience but it may also be lifesaving for the patient," he says. Patients are more likely to be seeing more doctors than previously and will lose continuity of care as more shift changes occur.

Will patients be happier swapping continuity of care for fresher doctors? Professor Pounder thinks not, but points out nobody has asked patients what they think.

Another group to be affected are hospital managers who are likely to see trust efficiency crippled with longer inpatient stays having a negative effect on a business’s bottom line. This won’t be compensated for with savings on junior doctors’ pay.

There is evidence of this, he writes, from an English hospital that did switch over to 48 hours for the juniors working in its acute unit in 2007.  

"Not only was continuity of care a problem, there was an even bigger breakdown – there were not enough doctors left to get the clinical jobs done during the daytime. Fewer investigations were ordered, less patients examined, poorer continuity notes written, fewer relatives seen, and slower discharge drugs or letter."

Ironically the EWTD, a piece of health and safety legislation is going to lead to a risk in patient safety, he says.

Whilst a legal rota over 24 hours can be worked out using maybe only seven or eight juniors and could work for the police or firefighters, it cannot work in training posts as more hours during evenings, nights and weekends don’t give juniors their much-needed training time.

Most of Europe is struggling with the legislation and many are flouting it. One solution might be to recruit more junior doctors and consultants. He advises all doctors to scrutinise their trust’s solutions and rotas for juniors from 2009.

Earlier this week, a BMA survey found gaps in nearly a third of respondees’ rotas might be leading to extra pressures on them to work extra hours. The doctors’ organisation said this was due to the training system brought in last year that meant vacant posts could only be filled once a year.

Clin Med 2008; 8: 126–7

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