Medical Training Programs Adapt to Duty-Hour Changes


A new study that showed no long-term decrease in patient outcomes after landmark 2003 reforms could portend good news for the latest duty-hour regulations implemented in 2011.

The Journal of General Internal Medicine report, “Teaching Hospital Five-Year Mortality Trends in the Wake of Duty Hour Reforms,” found that the 2003 changes were associated with “no significant change in mortality in the early years after implementation, and with a trend toward improved mortality among medical patients in the fourth and fifth years.” One of the authors says it’s not evident whether the improved outcomes are because of the reforms.

“We don’t think it’s an effect of work-hour reforms itself, but more likely a marker that teaching hospitals are staying ahead of the curve in general,” says Patrick Romano, MD, MPH, FACP, FAAP, a professor of medicine and pediatrics at the University of California at Davis School of Medicine in Sacramento.

Dr. Romano, who along with colleagues has been studying duty-hour reforms for years, says the new research shows that teaching hospitals were able to adapt over the long term to staffing rules. Researchers are now curious how health care will adapt to the more restrictive 2011 changes promulgated by the Accreditation Council for Graduate Medical Education (ACGME), which mostly limits first-year residents to a maximum 16-hour shift and older residents to 24 hours.

“Even though there were more handoffs [caused by the 2003 reforms], even though there were more opportunities for error due to handoffs, teaching hospitals were able to update,” Dr. Romano says. “Maybe that’s optimistic for 2011.

“Is the glass half full or half empty?”

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