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Study: Resident duty-hour restrictions don't worsen patient outcomes

Concerned for the safety of patients treated by potentially exhausted residents, the Accreditation Council for Graduate Medical Education (ACGME) capped individual resident shifts at 16 hours, and shifts for senior residents at 28 hours. However, the rules prompted new worries over increased patient handoffs and lost educational opportunities for residents.

A new study in Health Affairs examined whether the work hour rules, introduced in 2003, affected quality of care and mortality. Researchers used data from all hospitalizations in Florida between 2000-2009 that had records linked to physicians’ educational history, 4.6 million in total. Doctors with training before, during, and after the 2003 rule were compared to doctors with more than 10 years of experience. The researchers found that length of stay and mortality rates did not change under physicians trained under the duty-hour restrictions. Moreover, patients with more complicated cases fared somewhat better under care from those physicians.

While the restrictions don’t seem to have caused harm, the only improvements that seem to have been made are outcomes for the high-risk patients. There is nothing known yet on why high-risk patients fared better under physicians trained under the duty-hour restrictions.

“I think there are valid points about why we need physicians to work long hours,” Anupam Jena, MD, PhD, one of the lead authors on the study, said in an interview for Health Affairs. “In contrast, I would say, ‘What is the difference between working 80-90 hours vs. 100-120 hours?’ At the margin, I think those additional hours are probably not that critical to training physicians.”