하버드 의대 인턴들 잠 덜 재우니 의료과실 급증






실험 결과를 보도한 하버드대 소식지인 '하버드대 가제트'지 초기화면
"병원 인턴들의 잠을 더 자게 하라, 그러면 실수는 줄어든다."
당연해 보이는 이 명제를 하버드 의대가 직접 실험을 통해 사실임을 입증했다.
하버드 의대는 최근 전통적인 방식으로 '강행군'을 하는 인턴 1년차 그룹과 노동 강도를 현저히 낮춘 그룹의 성과를 분석해 이 같은 사실을 밝혀냈다고 하버드대 소식지인 '하버드대 가제트'와 의료 전문지인 '뉴잉글랜드 저널 오브 메디신'이 28일 보도했다.

연구는 보스턴의 '브리검 앤 여성 병원'에서 24명의 인턴을 두 그룹으로 나눠 실시됐다. 전통적 근무 그룹은 2교대제로 30시간 지속근무 방식으로 매주 85시간을 일했다. 반면 노동 강도를 낮춘 비교 그룹은 16시간 지속근무에 일주일에 65시간만 일하게 했다. 대신 일주일에 잠자는 6시간 정도 더 자게 했다.

결과는 극적이었다. 전통적 근무 그룹은 비교 그룹보다 36% 더 많은 중대 의료 과실을 저질렀다. 약 처방에서 중대한 과실은 21%나 많았고, 심각한 진단 과실은 무려 5.6배나 많은 것으로 나타난 것.

특히 전통적 근무그룹에서 발생한 실수는 많은 이들의 가슴을 쓸어내리게 한다. 예를 들어, 한 인턴은 환자의 오른 쪽 가슴에 주입하게 돼 있던 튜브를 왼쪽에 주입하려다 이를 목격한 레지던트의 제지로 중단했다. 또 한 인턴은 선천성 심장질환을 앓고 있는 환자의 상태가 양호하다고 진단했으나 숙련된 간호사는 그 환자가 호흡 곤란을 느끼고 있음을 확인하기도 했다. 이 같은 인턴들의 실수로 한 환자는 장시간 동안 심장 박동 증가로 고생했으며 또 한 환자는 안정제의 과용으로 심장 박동이 느려져 고생했다는 것.

이 연구를 진행한 하버드 의대 찰스 체이즐러 교수는 "이런 모든 실수들은 심각한 사고를 부를 가능성이 있는 실수들이었다"며 "다행히도 대부분의 실수들은 사전에 발견됐거나 발견되지 못해도 심각한 사고로 이어지지는 않았다"고 말했다.

체이즐러 교수는 "반응 시간이 낮아지고, 판단과 학습에 장애가 생기며 주의력이 떨어지는 등 잠을 줄임으로써 생기는 비용은 잘 알려져 있다"며 "이런 지식을 이제 의료계에도 적용할 때가 됐다"고 말했다. 실제로 다른 연구 결과에 따르면 하룻밤을 새고 나면 혈중 알콜 농도 0.1% 상태와 비슷한 상태가 된다는 것. 이번 연구를 함께 진행한 스티븐 로클리 교수는 "이번 연구 결과는 미국 내에서 현재 교육받고 있는 인턴과 레지던트, 간호사 등 10만명의 의료인력과 관련해 중요한 함의를 던지는 것"이라고 말했다.

이 같은 연구결과는 국내의 의료 현실에서도 시사하는 바가 크다. 전국 전공의협의회가 올해 초 회원 2492명을 대상으로 조사한 결과 51.4%가 주 100시간 이상을 근무하고 있는 것으로 나타났으며 3명중 2명꼴로 주3회 이상 야간당직 근무를 하고 있는 것으로 나타났다. 하버드대 연구의 전통적 그룹의 근무시간을 초과하는 셈이다. 실제로 전공의협의회 김대성 회장도 "하루 16시간이 넘는 살인적인 근무를 하다보면 누적된 피로로 인해 실수가 생길 수 있다"며 "이 같은 열악한 환경은 곧 환자에 대한 피해로 이어질 수 있다"고 말했다.

by 선대인 2008. 9. 4. 17:15
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