I have several friends who are doctors or nurses, and have talked with most of them about this. They all parrot the "doctor/nurse-patient continuity" line, but when pressed as to whether fewer handoffs actually outweigh the effects of exhaustion on outcomes, they all seem to take it as a given that it does, without being able to support it.
I suspect that, even if fewer handoffs does take an edge over exhaustion, the handoff process could be improved greatly; from what I'm told, handoff processes vary wildly, often aren't formalized, and even when they are, adherence to process is pretty lax, in part due to the effects of exhaustion.
It’s really interesting to do workflow analysis in clinical settings. It’s not uncommon to run into “we do it this way because that’s the way we’ve always done it” situations.
There is also a bit of machismo/pride for the shifts worked thing, which isn’t helpful.
I suspect that, even if fewer handoffs does take an edge over exhaustion, the handoff process could be improved greatly; from what I'm told, handoff processes vary wildly, often aren't formalized, and even when they are, adherence to process is pretty lax, in part due to the effects of exhaustion.