The 2011 limits placed on resident duty hours appear to have had no effect on patient deaths, patient outcomes or residents’ examination performance, according to two studies published this month in JAMA.
After setting an 80-hour work week limit for residents in 2003, the Accreditation Council for Graduate Medical Education (ACGME) further restricted residents’ work hours in 2011, including:
- Limiting first-year residents to 16 hours of continuous in-hospital duty
- Requiring that residents have at least 8 hours free between shifts
- Providing residents in-house for 24 hours with up to 4 hours for transfer of care activities and requiring at least 14 hours off between shifts
In one study—one of the first national empirical evaluations of the ACGME’s 2011 duty hour reform—researchers found no association with a change in surgical patient outcomes or resident examination performance after comparing data from teaching and nonteaching hospitals in the two years before and after reforms were implemented.
“This could indicate that current policies should continue forward as they are,” the study said. “Conversely, the potential harm from poor continuity of care, increased handoffs, trainees feeling unprepared to practice and concern regarding residents developing a shift-work mentality engendered by these policies could suggest that duty-hour reform may require significant revision or reconsideration.”
The other study found no significant differences in 30-day mortality or readmission rates after analyzing nearly 6.4 million admissions, including almost 2.8 million Medicare patients at 3,104 hospitals in the two years before and the first year after reform. The study is one of the first national evaluations of association between the 2011 duty-hour reform and patient outcomes.
AMA policy supports duty-hour research to explore a variety of issues, including patient safety, preparedness for practice, workload and patient volume, handoffs, and professionalism. A report from the AMA Council on Medical Education encourages the study of innovative models of duty-hour requirements, including potentially creating specialty- or rotation-specific duty-hour requirements that would optimize competency-based learning opportunities.
In March, the ACGME announced it would waive certain duty-hour standards for two large, national, multi-institutional resident trials. The core standards of 80-hour work weeks (averaged over four weeks), one day off for every seven worked (averaged over four weeks) and call no more frequently than every third night will remain in place for both trials.
The AMA supports the ACGME in its duty-hours investigation and is urging the ACGME to continue offering residency program incentives to ensure compliance with the standards, meeting with peer-selected or randomly selected residents during site visits, and collecting and sharing data on at-home call.
