December 7, 2007

1. IOM Committee Studies Resident Schedules and Patient Safety

2. NIH Alters ‘Error Correction Window’ for Grants Submitted Electronically

1. IOM Committee Studies Resident Schedules and Patient Safety

The Institute of Medicine (IOM) Committee on Optimizing Graduate Medical Trainee Schedules to Improve Patient Safety met this week to begin a year-long study on resident duty hours and patient safety. The committee will recommend strategies for implementing optimized resident schedules.

During the meeting, experts presented information on patient safety; medical education policy and financing; and sleep medicine. ACP Senior Vice President of Medical Education and Publishing Steven E. Weinberger, MD, presented program director and resident perceptions of the effects of duty hour regulations on medical education. Included on Dr. Weinberger’s panel were resident representatives of the American Medical Association and the American Medical Student Association who urged the committee to protect high-quality education when considering altering resident schedules and described the Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements as lax, poorly implemented, and lacking evidence.

According to Christopher P. Landrigan, MD, Harvard Medical School Assistant Professor of Pediatrics and Medicine and Brigham and Women’s Hospital Sleep and Patient Safety Program Director, “even were the ACGME requirements perfectly enforced…they would be unsafe.” Dr. Landrigan emphasized that efficiency of learning and consolidation of memory decreases when residents are sleep deprived; he identified a 24 to 30 hour shift as unsafe “on the basis of the best available scientific evidence.” In addition, Dr. Landrigan encouraged the committee to conduct a formal cost-effectiveness analysis of options for reducing resident duty hours. According to his testimony, up-front costs of hiring providers to fill in for residents “are likely to be mitigated by savings due to decreased medical errors and injuries.”

Association of Program Directors in Internal Medicine Councilor and Vice Chair for Education at St. Luke’s-Roosevelt Hospital Ethan D. Fried, MD, sat on the Work Hours, Patient Safety, and Enforcement Panel presenting information on the “Drip System” his residency program uses to comply with ACGME duty hours regulations and ensure a culture of patient-centered and safe care.

On the same panel, L. Toni Lewis, MD, Executive Vice President of the Committee of Interns and Residents at Service Employees International Union Healthcare, recommended the IOM committee act on existing evidence and prohibit on-call shifts greater than 16-hours; make safe, evidence-based hour limits a national regulatory requirement across specialties and hospitals; and strip from ACGME and the hospital industry the enforcement mechanism for resident work hour limits and entrust it to an independent entity.

In addition, Peter Lurie, MD, Deputy Director of Public Citizen’s Health Research Group discussed the current systems Europe has implemented to reduce the resident work week based on current studies of sleep deprivation as it relates to resident performance and patient safety. The resident work week in Europe is 56 hours and implementation of a 48-hour week will take effect in 2009. Dr. Lurie called on the committee to take a similar, evidence-based approach to restructuring resident schedules.

2. NIH Alters ‘Error Correction Window’ for Grants Submitted Electronically

The National Institutes of Health (NIH) announced Friday, November 30, 2007, a change in its electronic grant submission policy. NIH grant applicants are currently allowed a five day “error correction window” to resolve any errors or warnings associated with the electronic grant application. The agency’s new policy limits the “error correction window” to two business days, effective Tuesday, January 8, 2008.

According to NIH, the agency hopes to define “on-time” submission as “having an error-free application (i.e. passes Grants.gov and eRA Commons system-enforced business rules without errors)” by 5:00 p.m. local time of the applicant’s organization on the day of the grant deadline. The current five business day policy was established during the roll-out of Grants.gov to assist applicants as they became acclimated to the system. As applicants have become acquainted with the system and as NIH has improved its processing time, the decision was made to shorten the “error correction window” to ultimately expedite the process of reviewing and awarding grants. Recent review of the November 5, 2007, R01 application cycle shows that 93% of applicants were able to successfully submit their applications within two submission attempts.

For more information on the NIH policy change, please visit the policy announcement on the NIH website.

The Alliance for Academic Internal Medicine—the nation’s largest academically focused specialty organization—consists of the Association of Professors of Medicine, the Association of Program Directors in Internal Medicine, the Association of Subspecialty Professors, the Clerkship Directors in Internal Medicine, and the Administrators of Internal Medicine.

Please contact AAIM Vice President for Policy Charles P. Clayton (cclayton@im.org), AAIM Policy Associate Nicole V. Baptista (nbaptista@im.org), or AAIM Policy Assistant Allison L. Haupt (ahaupt@im.org) at (202) 861-9351 with questions or comments about this week’s Merlin.