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Effect of medical resident duty hour reforms on patient outcomes

The JAMA Network Journals

An examination of the effect of resident duty hour reforms in 2011 finds no significant change in mortality or readmission rates for hospitalized patients, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new duty hour reforms for all ACGME-accredited residency programs. The revisions maintain the weekly limit of 80 hours set forth by the 2003 duty hour reforms but reduced the work hour limit from 30 consecutive hours to 16 hours for first­year residents (interns) and 24 hours for upper-year residents (with an additional 4 hours to perform transitions of care and participate in educational activities). Initial duty hour reforms in 2003 were prompted by wide­spread concern about the effects of resident fatigue. There has been concern that the 2011 duty hour reforms may adversely affect the quality of resident education, increase handoffs in care, and put both patient safety and outcomes at risk.

Mitesh S. Patel, M.D., M.B.A., M.S., of the Veterans Administration Hospital and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues evaluated the association of the 2011 ACGME duty hour reforms with mortality and readmissions among hospitalized Medicare patients during the first year after the reforms. The study analyzed Medicare patient admissions (6,384,273 admissions from 2,790,356 patients) to short-term, acute care hospitals (n = 3,104) with principal medical diagnoses of heart attack, stroke, gastrointestinal bleeding, or congestive heart failure or a classification of general, orthopedic, or vascular surgery.

After an analysis of the number of hospital admissions, deaths and readmissions in the two years before duty hour reforms compared with these figures in the first year after the reforms, the researchers found no significant positive or negative associations of duty hour reforms with 30-day mortality for any of the medical conditions or surgical categories in this study, and no significant positive or negative associations of these reforms with 30-day all-cause readmissions for combined medical conditions or combined surgical categories.

The authors write that their findings suggest that in the first year after the 2011 duty hour reforms, the goals of improving the quality and safety of patient care, as measured by decreased 30-day mortality and all-cause readmissions rates "were not being achieved. Conversely, concerns that outcomes might actually worsen because of decreased continuity of care have not been borne out."

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(doi:10.1001/jama.2014.15273; Available pre-embargo to the media at http://media.jamanetwork.com)

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