Study: Shorter Doctors' Hours Don't Affect Patient Outcomes

By Jane Farrell

A new study has found that there is no difference in the rate of death or rehospitalization of Medicare patients following a mandated reduction in the number of continuous hours a medical resident can work.

The study, published in JAMA, was conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania and The Children’s Hospital of Philadelphia.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) reduced the number of continuous hours residents can work, and this new study looked at the effect of reduced hours on patients.

“There has been a lot of speculation about the effect of the 2011 ACGME duty hour reforms on patient outcomes, so we looked at death and readmission rates at the national level,” said lead study author Mitesh S. Patel, MD, MBA, MS, assistant professor of Medicine and Health Care Management at Penn and an attending physician at the Philadelphia VA Medical Center. “Some hoped that by shortening intern shifts from 30 hours to 16 hours, less fatigued residents would lead to less medical errors and improved patient outcomes. Yet, others were concerned that shorter shifts would increase patient handoffs and leave less time for education, thereby negatively affecting patient outcomes. These results show that in the first year after the reforms, neither was true.”

For first-year residents (interns), the ACGME rules cut the maximum number of consecutive work hours from 30 hours to 16. For all other residents, the maximum number of consecutive work hours was reduced from 30 to 24 (with an additional four hours for transitions of care and educational activities).

In the study, investigators examined almost 6.5 million Medicare patient hospital admissions between July 2009 and July 2012. The patients were admitted for a number of conditions including heart attack, stroke, or congestive heart failure. Some patients faced surgery.

Study authors looked at 30-day mortality and readmission rates, using the ratio of residents to hospital beds as a measure of hospital teaching intensity in order to compare outcomes between more intensive and less intensive teaching hospitals, according to a news release from the University of Pennsylvania. They concluded that there were no relative changes in patient deaths or hospital readmissions during the period of time the study covered.

“Even though residents are working shorter shifts, these results should provide some confidence that in the first year after duty hour reforms there was no negative or positive associations with quality of care as measured by patient death and readmission,” added Patel. “In addition, the change in duty hours means that residents may have more time to sleep and balance their other personal and academic commitments.”