Allowing residents the flexibility to work longer shifts than allowed in the United States and to take less time off between shifts to provide continuity of patient care is not associated with a greater risk to patients of early serious postoperative complications or death, according to study results involving 117 U.S. general surgery residency programs and 151 hospitals.
This flexibility also was reported by residents to make it less likely they would need to leave during an operation or hand off an active patient care issue to another provider, notes lead study investigator Karl Bilimoria, MD, MS, FACS, a faculty scholar at the American College of Surgeons (ACS) and director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago. Bilimoria announced the study results at a recent ACS meeting.
Compared with current resident duty hour requirements, some of which have been in place for 12 years, implementation of less restrictive work hour policies also showed no significant difference in residents’ self-reported satisfaction with their overall well-being and quality of their training. The study is called the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial. (An abstract and access to the full study are available online at http://tinyurl.com/j362869.) The FIRST Trial is the first national randomized trial of resident duty hour policies, according to the investigators.
“Making duty hour policies more flexible for surgeons-in-training appears to be safe for patients and acceptable to the trainees,” Bilimoria says. “This is the first time we have high-level national prospective evidence to inform resident duty hour policies.” Until now, there has been little high-quality data to show the effect of increased work hour restrictions on surgical patient care, he says.
Duty hour policies were revised nationally in 2003 and 2011 by the Accreditation Council for Graduate Medical Education, the accrediting and standards-setting body for about 9,500 U.S. medical residency programs, of which 252 are general surgery programs. Of those 252 programs, 117 participated in the FIRST Trial. Made to address concerns about patient safety and residents’ well-being, the initial reform limited residents’ work hours to 80 per week, capped overnight shift lengths, and mandated minimum time off between shifts. The more recent changes further shortened the shift length for interns and increased residents’ time off work after a 24-hour shift.
Although the reforms from the Accreditation Council for Graduate Medical Education aimed to protect patients against trainees’ fatigue-related errors, Bilimoria points out that the newest restrictions increased handoffs.
“In surgery, this more frequent turnover may compromise continuity of patient care, potentially jeopardize patient safety, and decrease the quality of resident education by forcing residents to leave at critical times, such as in the middle of an operation or while stabilizing a critically ill patient,” he said.