Work-hour rules that limit residents to an average 80-hour workweek have resulted in fewer in-hospital transfers to intensive care, fewer pharmacist interventions to avoid medication errors, and more frequent discharge to home or rehabilitation services, according to research in the July Annals of Internal Medicine.
Duty-Hour Limits Improve Some Outcomes, Study Reports
By News Staff
6/26/2007
The study is among the first to examine the impact of duty-hour limitations, which were implemented by the Accreditation Council for Graduate Medical Education, or ACGME, in July 2003. ACGME launched the duty-hour rules to ensure that residents got enough rest to prevent fatigue-related errors, without impinging on their learning environment.
As a result of the limits, teaching hospitals had to reorganize work schedules, often sending residents home at night and turning patient care over to nonresident physicians who provided after-hours care. The reorganization increased the number of physicians involved in each patient's care, thereby increasing the amount of discontinuity in care.
To determine if that discontinuity had any impact on patient care, researchers compared outcomes for internal medicine patients before and after July 2003 and between teaching and nonteaching floors at Yale-New Haven Hospital.
"We found that, relative to what would have been expected without the regulation, work-hour limits were associated with statistically significant improvements in three outcomes: ICU state (decrease 2 percent), discharge to home or rehabilitation versus elsewhere (increase 5 percent), and pharmacist interventions to prevent errors (decrease 1.9 interventions per 100 patient-days)," the authors write.
No statistically significant differences were found in four other outcomes: length of stay, 30-day readmission rate to the study hospital, drug-drug interactions or in-hospital death.
The authors surmised several factors could have contributed to the improved outcomes, despite the increased discontinuity. Among them are
As a result of the limits, teaching hospitals had to reorganize work schedules, often sending residents home at night and turning patient care over to nonresident physicians who provided after-hours care. The reorganization increased the number of physicians involved in each patient's care, thereby increasing the amount of discontinuity in care.
To determine if that discontinuity had any impact on patient care, researchers compared outcomes for internal medicine patients before and after July 2003 and between teaching and nonteaching floors at Yale-New Haven Hospital.
"We found that, relative to what would have been expected without the regulation, work-hour limits were associated with statistically significant improvements in three outcomes: ICU state (decrease 2 percent), discharge to home or rehabilitation versus elsewhere (increase 5 percent), and pharmacist interventions to prevent errors (decrease 1.9 interventions per 100 patient-days)," the authors write.
No statistically significant differences were found in four other outcomes: length of stay, 30-day readmission rate to the study hospital, drug-drug interactions or in-hospital death.
The authors surmised several factors could have contributed to the improved outcomes, despite the increased discontinuity. Among them are
- reduced fatigue among residents may have improved clinical care;
- the increase in discontinuity may not have been enough to affect outcomes;
- greater clinical involvement by more senior physicians may have compensated for greater discontinuity; and
- use of night-shift physicians with more clinical experience than residents may have improved outcomes, despite the physicians' lack of knowledge about the patients.
