Limits to resident hours don't improve patient safety

Efforts to cut down on the hours logged by doctors in training have had no measurable impact on patient outcomes, according to two new studies published in the Journal of the American Medical Association.

The first study, led by researchers at the University of Pennsylvania (UPenn), looked at whether the controversial reforms put in place by the 2011 Accreditation Council for Graduate Medical Education (ACFME) affected patient mortality rates and readmissions. The other study, conducted by the American College of Surgeons and Northwestern University, examined the reforms' effect on surgery outcomes and in resident examination performance. Both found that there was no significant difference associated with the duty-hour restrictions, contradicting both dire predictions about the harms of the reforms and some advocacy groups' optimism about their benefits.

The 2011 reforms--which reduced the maximum work-hour limit from 30 to 16 for first-year residents--expanded on those first implemented in 2003, which were "prompted by widespread concern about the effects of resident fatigue, including deaths due to medical errors," according to the UPenn study. But the initial reforms, which set an 80-hour work limit for residents, also weren't effective in improving patient outcomes, according to previous studies on the subject.

Instead of welcoming the reforms as a way to prevent fatigue, many program directors and residents worried that the quality of the education received by residents could suffer as a result of the reforms, FierceHealthcare previously reported, an issue also addressed by the UPenn researchers. A 2009 study even suggested the reforms could cost teaching hospitals as much as $1.6 billion in additional labor costs.

Both studies conclude that while further research is needed, their findings suggest that ACFME should re-examine its 2011 reforms.

The author of the second study, Karl Bilimoria, M.D., an assistant professor of surgery at Northwestern University Feinberg School of Medicine in Chicago, goes even further.

"We think that these restrictions are limiting continuity of care and hurting care," he told Healthday. "In absence of an improvement in outcomes, we would suggest that these rules are not necessary. They should be repealed."

To learn more:
- read the UPenn study
- check out the Northwestern study
- read the Healthday article

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