Stricter Duty-Hour Regulations Tied to Diminished Patient Care


A new report has linked recent changes made to hospital residents’ duty-hour regulations with a reduction in some aspects of patient care.

The study compared the work model for duty-hour regulations implemented in 2011 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, with less restrictive guidelines adopted in 2003. Previously, 30-hour shifts were permitted for all residents.

Researchers at Johns Hopkins University in Baltimore measured residents’ sleep duration, hospital admission volumes, residents’ educational opportunities, the number of handoffs, and patient satisfaction surveys during shifts worked by internal-medicine house staff trainees under both models. The researchers used a three-month crossover design.

Residents slept longer, as expected, but the data showed more handoffs, fewer chances to attend teaching conferences, and reduced intern presence during daytime shifts when trainees followed the more recent work model. The study authors associated the model adopted in 2011 with deterioration in continuity of patient care and perceived quality of care. One of the four house staff teams perceived such a reduced quality of patient care that it terminated the project early.

However, one resident program director says much more research needs to be done to determine the efficacy of the new work-hour rules, particularly on patient and resident satisfaction. “There are things that go along with duty-hours, such as access to information and really well-designed handoff systems, that I think would bring out the safety advantages of duty-hours,” says Ethan Fried, MD, MS, FACP, associate professor of clinical medicine, Columbia College of Physicians and Surgeons and vice chair for education, department of medicine, St. Luke’s-Roosevelt Hospital, both in New York, and a former president of the Association of Program Directors in Internal Medicine.

“One of the reasons you’re not seeing an inflection in safety is because you have duty-hours, but you haven’t got the other system that you need to make duty-hours work. What people have been focused on is pure safety, and that we haven’t been able to demonstrate actual improvement in morbidity, mortality or complications,” he adds. “It’s one of those cases where I don’t know if we’re necessarily asking the right questions.”

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