Residents’ Hours Decline, But Safety Doesn’t Improve

Limiting residents’ work hours has no effect on patient safety, one study suggests — even though improving safety was one of the main reasons the limits for physicians-in-training were instituted in the first place.

“In the year after implementation of the 2011 work-hour reforms, we found no change in ICU admissions, inpatient mortality, 30-day readmission rates, length of stay … compared with patients treated by hospitalists,” says the observational study in the Journal of Hospital Medicine.

Researchers analyzed outcomes from patients admitted to The Johns Hopkins Hospital from July 2008 through June 2012, categorizing admissions as pre-reform (through June 30, 2011) and post-reform (after that date).

“We were surprised to find no difference in any of the patient safety outcomes we looked at one year after implementation of new work hours regulations,” says Lauren Block, MD, lead researcher. “Clearly, additional studies of the work hours regulations are needed to help us better understand the impact on patient safety.”

The 2011 reform provides that first-year residents should work no longer than 16-hour shifts.

“Small studies of the 2011 recommendations have shown increased sleep duration and decreased burnout, but also an increased number of handoffs and increased resident concerns about making a serious medical error,” the study report stated.

“It is unclear why improvements in patient safety were not identified in the current study. The 2011 reforms were more broad-based than some of the preliminary studies of reduced work hours, and therefore additional variables may be at play. For instance, challenges related to decreased work hours, including the increased number of handoffs in care and work compression, may require specific interventions to produce sustained improvements in patient safety.”