New limits on medical resident workhours implemented in 2011 appear to have had no effect on patient deaths or serious complications, according to two new studies published in JAMA.
The Accreditation Council for Graduate Medical Education originally set an 80-hour workweek in 2003, but refined the work rules in 2011 to limit shifts for first-year residents, also known as “interns,” to 16 consecutive hours a day and 24 hours for other residents. Both had previously been limited to 30 consecutive hours. The new rules also included requirements on time off between shifts and banned the practice of resident “moonlighting” during time off.
In one study, researchers with the Philadelphia VA Medical Center and Perelman School of Medicine at the University of Pennsylvania, also in Philadelphia, analyzed almost 6.4 million admissions involving almost 2.8 million Medicare patients at 3,104 hospitals. They compared data from the two years before reform and the first year after and found no significant differences in 30-day mortality and readmissions.
The researchers noted many reasons for both the lack of negative and positive effects.
“Hospitals that did adopt the new reforms may have leveraged faculty or hospitalists with greater experience than residents to care for Medicare patients,” the researchers wrote. “Reforms focused on improving faculty supervision that could have resulted in improved patient outcomes, potentially compensating for any adverse effects of increased patient handoffs.”
They also noted how their study focused on deaths and readmissions, but measurements of other outcomes such as patient-safety issues or other complications may be better indicators of the effects of less resident fatigue and more patient handoffs.
In the other study, researchers with the American College of Surgeons and the American Board of Surgery compared similar data from 23 teaching and 31 nonteaching hospitals in the two years before reforms were implemented and in the two years after. They found no association between the duty hours and postoperative adverse outcomes. Also, there were no significant changes in residents’ written or oral exam scores for the years studied.
“First, there is no evidence of worsened patient care or resident education, and given assumed improvements to resident well-being, this could indicate that current policies should continue forward as they are,” the authors concluded. “Conversely, the potential harm from poor continuity of care, increased handoffs, trainees feeling unprepared to practice, and concern regarding residents developing a shift-work mentality engendered by these policies could suggest that the duty-hour reform may require significant revision or reconsideration. Although many of these concerns have not been substantiated by consistent evidence, they reflect the intense interest duty-hour reform has generated from the clinical and educational community.”
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