Resident work-hour limits may increase patient complications

Restrictions on duty hours for surgical residents do not improve patient outcomes, and may contribute to patient complications and certification exam failure rates, according to a research paper published in the Annals of Surgery.

Researchers, led by Najma Ahmed, M.D., a trauma surgeon at St. Michael's Hospital in Toronto, analyzed 135 articles on how duty hours affected clinical and educational results. Based on the articles, duty-hour restrictions did not correlate with any improvement in patient outcomes, and some studies indicated they increased complication rates, according to the paper.

In 2011, Quebec limited on-call shifts to 16 hours, and last year a National Steering Committee on Resident Duty Hours called for such limits in all provinces, according to a statement from St. Michael's.

"In surgery, recent changes in hours for residents are not consistently associated with improved resident well-being and may have negative impacts on patient outcomes and performance on certification exams," Ahmed said in the statement.

Part of the problem, Ahmed said, is that shorter hours mean more handovers and therefore less continuity of care. The shorter shifts can also prevent residents from following the course of a patient's recovery, making them less likely to notice complications.

A February study in the Journal of Hospital Medicine similarly found no improvement in patient safety from limiting general medicine residents' duty hours, FierceHealthcare previously reported, although a study last year suggested restrictions decreased operating case loads.

To learn more:
- read the research paper (.pdf)
- here's the statement