Health Policy$ense

Shortened Shifts for Residents Not Associated with Patient Outcomes

Today in JAMA, LDI Senior Fellows Mitesh Patel, Kevin Volpp and colleagues report that 2011 resident duty hour reforms were not associated with changes among Medicare beneficiaries in 30-day mortality or hospital readmissions in the first year of implementation.  As Patel notes,

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.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) limited residents to an 80-hour work week, prompted by concerns for patient safety.  But previous studies by Volpp, Silber and colleagues found no changes associated with the 2003 reforms in 30-day mortality, readmissions, probability of prolonged length of stay, or other indicators of patient safety.  The 2011 reform reduced the maximum consecutive work hours from 30 to 16 for first-year-residents and 24 for more senior residents.

Another article in the same edition of JAMA finds no association between the ACGME 2011 reforms and  changes in general surgery patient outcomes or in resident examination performance. What should we make of this consistent lack of quality effects? A JAMA editorial points out that the number of resident hours is just one variable in a complex system, and highlights more promising approaches that address many relevant variables, such as supervision, transitions of care, professionalism, fatigue mitigation, and institutional processes around safety and quality.

The Patel/Volpp article is free and worth a full read. Other authors are Dylan Small, Alexander Hill, Orit Even-Shoshan, Lisa Rosenbaum, Richard Ross, Lisa Bellini, Jingsan Zhu, and Jeffrey Silber.

Bonus:  Mitesh Patel and Kevin Volpp explain their findings in a JAMA video