Have Resident Duty Hour Regulations Improved Patient Outcomes? Maybe Not.

dutyhoursRed  In 2003, the ACGME implemented what was then received as a rather dramatic restriction on resident duty hours: weekly limit of 80 hours and consecutive work hour limit of 30 hours. In 2011, the ACGME further revised resident duty hour regulations, this time decreasing the consecutive work hour limit to 16 hours for first year residents and 24 hours for upper-year residents.  This observational study assessed mortality and readmission rates for Medicare patient admissions 2 years before versus 1 year after the 2011 duty hour regulations in teaching intensive and less teaching intensive hospitals. In the 4 million+ admissions pre vs 2 million+ admissions post the 2011 duty hour regulations, there were no significant differences in 30-day mortality or readmission rates in more intensive vs less intensive teaching hospitals. What is unknown is how adherent these teaching hospitals were to the duty hour regulations, or what impact the care provided by more experienced faculty or hospitalists (in place of duty-hour max’ed residents) may have had on these outcomes. While many express concerns about unintended consequences of duty hour regulations, such as limiting resident education and increasing handoffs which may adversely affect patient outcomes, neither this study nor others that have come before it provide conclusive evidence that duty hour regulations have had a positive or negative impact on patient outcomes. — Sarang Kim, MD.

Patel MS, Volpp KG, Small DS, Hill AS, Even-Shoshan O, Rosenbaum L, Ross RN, Bellini L, Zhu J, Silber JH Association of the 2011 ACGME resident duty hour reforms with mortality and readmissions among hospitalized Medicare patients. JAMA. 2014 Dec 10;312(22):2364-73.

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