Resident work-hour restrictions don't help patient outcomes

Although restrictions on the number of hours resident physicians work are meant to reduce medical errors, the work-hour limits do not improve patient safety, according to a study published in the Journal of the American College of Surgeons.

In 2011, the Accreditation Council for Graduate Medical Education revised residents' work-hour limits in order to reduce fatigue-related medical errors. The revisions limit first-year residents to work shifts of 16 continuous hours at the most and require that a senior physician directly supervise them at all times when in-house. The restrictions also require that residents receive a break of at least 14 hours off following a 24-hour shift. 

But researchers found there was no significant difference in surgical outcomes between the year before the revisions and the two years after, according to Ravi Rajaram, M.D., of the American College of Surgeons, and colleagues.

Rajaram and his team analyzed mortality and complications data within 30 days of an operation in orthopedic surgery, urology, vascular surgery, obstetrics/gynecology and neurosurgery. The researchers first compared outcomes at teaching and non-teaching hospitals. Although teaching hospitals should be particularly susceptible to reduced resident duty hours, Rajaram and his team found no significant difference between the altered duty hour requirements and outcomes.

Not only do the changes not affect outcomes, they may complicate care delivery, as residents working 24-hour shifts may spend no more than four hours on the process of transferring patients to another provider, or "handoffs," according to Rajaram.

"These restrictions impose obstacles for residents and their residency programs," he said in a statement announcing the findings. "Under the new policies, residents are handing off patients more often, and patient handoffs are one of the most common preventable causes of serious patient harm events."

The findings echo two similar 2014 studies from the University of Pennsylvania and Northwestern University in collaboration with the American College of Surgeons (ACS). Rajaram called for further research into the issue, such as randomized clinical trials to determine the best model for resident duty hours.

To learn more:
- read the study abstract
- here's the statement

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