Plans to update European working time legislation in disarray

EWTD is to improve health and safety of patients and doctors

31 December 2008

A number of articles in the lay press and this in the BMJ highlight possible consequences of limiting work hours for junior doctors to 48 h/week from August 2009 as required by the European Working Time Directive. While the concerns raised by the British Medical Association will be important to address as the Directive is implemented, it is essential that the reasons why the Directive was implemented in the first place be kept firmly in mind - to improve patient and staff safety. The difference between 56 and 48h/week may appear small when averaged over 6 months (as is the current standard) but the difference in any given week can be considerable, as doctors still legally work nearly 80h a week in some weeks. Such extreme work hours have been repeatedly demonstrated to endanger both patients and doctors. The argument that the 48h limit will have a negative impact on both patients and junior doctors performance or education is not supported by any objective data. On the contrary, several US studies provide robust evidence to show that doctors working long hours make mistakes that harm patients and themselves and that reducing work hours and shift duration improves patient safety. In the UK, recent data from our own studies show that implementation of a 48h EWTD-compliant rota, if designed appropriately and paired with efforts to improve sleep hygiene, is associated with as much as a 33% reduction in medical error rates as compared to current working practices within a 56-h/week limit. Limiting consecutive night shifts to no more than three, limiting shift duration to 12h, and abolishing rapid day-to-night ‘slam-shifts are all measures that reduce acute and chronic partial sleep deprivation, facilitate adaptation of circadian rhythms and enhance recovery sleep, thereby reducing sleepiness and improving doctors performance and patient safety.

It is unquestionably the case that more doctors and health-care providers are needed to implement a 48h work week optimally and we support the plea to the Government for ring-fencing allocated budgets for provision of more staff. Changes in educational models will also be needed to train junior doctors most effectively under this newer system. Given the high negative impact of long hours on doctors ability to perform safely, however, we cannot ignore an opportunity that has the potential to improve patient safety and junior doctors working conditions. If implemented properly, the EWTD Directive provides that opportunity and should be embraced.

Competing interests: None declared

Competing interests: None declared

Francesco P Cappuccio, Professor

Steven W Lockley, Christopher P Landrigan (Harvard Medical School, Boston)

University of Warwick Medical School, Coventry, CV2 2DX

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