Posted on December 30, 2014

Pic: Getty

An examination of the effect of resident duty hour reforms in 2011 finds no significant change in mortality or readmission rates for hospitalised patients or outcomes for general surgery patients, according to two studies in the December 10 issue of JAMA, a theme issue on medical education.

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) in the US implemented new duty hour reforms for all ACGME-accredited residency programmes for doctors in training.

The revisions maintain the weekly limit of 80 hours set forth by the 2003 duty hour reforms, but reduced the work hour limit from 30 consecutive hours to 16 hours for first­-year residents (interns) and 24 hours for upper-year residents (with an additional four hours to perform transitions of care and participate in educational activities).

Initial duty hour reforms in 2003 were prompted by wide­spread concern about the effects of doctor fatigue. There has been concern that the 2011 duty hour reforms may adversely affect the quality of resident education, increase hand-offs in care, and put both patient safety and outcomes at risk.

In one study, Dr Mitesh Patel of the Veterans Administration Hospital and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, and colleagues evaluated the association of the 2011 ACGME duty hour reforms with mortality and readmissions among hospitalised Medicare patients during the first year after the reforms. The study analysed Medicare patient admissions (6,384,273 admissions from 2,790,356 patients) to short-term, acute care hospitals (n=3,104) with principal medical diagnoses of heart attack, stroke, gastrointestinal bleeding, or congestive heart failure or a classification of general, orthopaedic, or vascular surgery.

After an analysis of the number of hospital admissions, deaths and readmissions in the two years before duty hour reforms compared with these figures in the first year after the reforms, the researchers found no significant positive or negative associations of duty hour reforms with 30-day mortality for any of the medical conditions or surgical categories in this study, and no significant positive or negative associations of these reforms with 30-day all-cause readmissions for combined medical conditions or combined surgical categories.

In the second paper, Dr Ravi Rajaram of the American College of Surgeons, Chicago, and colleagues conducted a study to determine if the 2011 ACGME duty hour reform was associated with a change in general surgery patient outcomes or in resident examination performance.

The study examined general surgery patient outcomes two years before (academic years 2009-2010) and after (academic years 2012-2013) the 2011 duty hour reform.

In the main analysis, 204,641 patients were identified from 23 teaching (n=102,525) and 31 non-teaching (n=102,116) hospitals. In adjusted analyses, the researchers found that the duty hour reform was not associated with a significant change in death or serious illness in either post-reform year 1 or post-reform year 2 or when both post-reform years were combined.

There was also no association between duty hour reform and any other postoperative adverse outcome.

Average in-training examination scores did not significantly change from 2010 to 2013 for first-year residents, for residents from other postgraduate years, or for first-time examinees taking the written or oral board examinations during this period.

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