PHILADELPHIA — In the first year after the Accreditation Council for Graduate Medical Education (ACGME) reduced the number of continuous hours that residents can work, there was no change in the rate of death or readmission among hospitalized Medicare patients, according to a new study published in JAMA. The study was led by researchers at the Perelman School of Medicine at the University of Pennsylvania and The Children’s Hospital of Philadelphia.
“There has been a lot of speculation about the effect of the 2011 ACGME duty hour reforms on patient outcomes, so we looked at death and readmission rates at the national level,” said lead study author Mitesh S. Patel, MD, MBA, MS, assistant professor of Medicine and Health Care Management at Penn and an attending physician at the Philadelphia VA Medical Center. “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 2011, the ACGME implemented new restrictions in teaching hospitals across the United States, limiting the number of consecutive hours that residents can work. For first-year residents (interns), the rules cut the maximum number of consecutive work hours from 30 hours to 16. For all other residents, the maximum number of consecutive work hours was reduced from 30 hours to 24 (with an additional four hours for transitions of care and educational activities). The revisions did, however, maintain the 80 hour-per-week cap that was instituted in 2003, following decades in which residents routinely worked more than 100 hours a week.
This study examined nearly 6.4 million Medicare patient hospital admissions between July 2009 and June 2012. The patients were admitted for heart attack, stroke, gastrointestinal bleeding or congestive heart failure, or for general, orthopedic, or vascular surgery. The study authors evaluated 30-day mortality and readmission rates, using the ratio of residents to hospital beds as a measure of hospital teaching intensity in order to compare outcomes between more intensive and less intensive teaching hospitals. They found no relative changes in patient deaths or hospital readmissions during this time period.
“Even though residents are working shorter shifts, these results should provide some confidence that in the first year after duty hour reforms there was no negative or positive associations with quality of care as measured by patient death and readmission,” added Patel. “In addition, the change in duty hours means that residents may have more time to sleep and balance their other personal and academic commitments.”
The other Penn study authors include Kevin G. Volpp, MD, PhD, Dylan S. Small, PhD, Alexander S. Hill, BS, Orit Even-Shoshan, MS, Richard N. Ross, MS, Lisa Bellini, MD, Jingsan Zhu, MBA, and Jeffrey H. Silber, MD, PhD. The study was funded in part by a National Heart, Lung and Blood Institute grant (R01-HL094593). Patel’s work was supported by the Department of Veteran Affairs and the Robert Wood Johnson Foundation.
Editor’s Note: Additional media resources for this study, including video, are available on the JAMA website.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
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