Shorter hours for interns and resident physicians, instituted by the Accreditation Council for Graduate Medical Education in 2011, have had no significant effect on patient outcomes, according to an analysis of more than 6 million patient records by researchers at the University of Pennsylvania's Perelman School of Medicine and the Children's Hospital of Philadelphia.
The study, published in JAMA, examined nearly 6.4 million Medicare patient hospital admissions between July 2009 and June 2012. The patients were admitted for heart attack, stroke, gastrointestinal bleeding or congestive heart failure, or for general, orthopedic, or vascular surgery.
There has been a lot of speculation about the effect of the 2011 ACGME duty hour reforms on patient outcomes, so we looked at death and readmission rates at the national level, said lead study author Mitesh S. Patel, M.D. Some hoped that by shortening intern shifts from 30 hours to 16 hours, less fatigued residents would lead to less medical errors and improved patient outcomes. Yet, others were concerned that shorter shifts would increase patient handoffs and leave less time for education, thereby negatively affecting patient outcomes. These results show that in the first year after the reforms, neither was true.
The study authors evaluated 30-day mortality and readmission rates, using the ratio of residents to hospital beds as a measure of hospital teaching intensity in order to compare outcomes between more intensive and less intensive teaching hospitals. They found no relative changes in patient deaths or hospital readmissions during this time period.
In 2011, the ACGME implemented new restrictions in teaching hospitals across the United States, limiting the number of consecutive hours that residents can work. For first-year residents (interns), the rules cut the maximum number of consecutive work hours from 30 hours to 16.
For all other residents, the maximum number of consecutive work hours was reduced from 30 hours to 24 (with an additional four hours for transitions of care and educational activities). The revisions did, however, maintain the 80 hour-per-week cap that was instituted in 2003, following decades in which residents routinely worked more than 100 hours a week.
Even though residents are working shorter shifts, these results should provide some confidence that in the first year after duty hour reforms there were no negative or positive associations with quality of care as measured by patient death and readmission, added Patel. In addition, the change in duty hours means that residents may have more time to sleep and balance their other personal and academic commitments.
The full study is available here.
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