Resident Duty-Hour Reform Associated with Increased Morbidity Following Hip Fracture
ABSTRACT The Accreditation Council for Graduate Medical Education implemented resident duty-hour reform for orthopaedic resident surgeons in the United States on July 1, 2003. This study sought to determine whether the change in duty-hour regulations was associated with relative changes in mortality and morbidity for patients with a hip fracture treated in hospitals with and without resident teaching involved in the delivery of medical care.
The Nationwide Inpatient Sample database was used to identify 48,430 patients treated for hip fracture during the years of 2001 to 2002, before resident duty-hour reform, and the years of 2004 to 2005 after reform. Logistic regression was used to examine the change in morbidity and mortality in nonteaching compared with teaching hospitals before and after the reform, adjusting for patient characteristics and comorbidities.
An increase in the overall incidence of perioperative morbidity was observed in both teaching and nonteaching hospitals, suggesting a general increase in the severity of illness of the patients with a hip fracture. A significant increase in the rate of change in the incidence of perioperative pneumonia, hematoma, transfusion, renal complications, nonroutine discharge, costs, and length of stay was seen in patients who underwent treatment for a hip fracture in the years after the resident duty-hour reforms at teaching institutions. Resident duty-hour reform was not associated with an increase in mortality.
Resident duty-hour reform was associated with an accelerated rate of increasing patient morbidity following treatment of hip fractures in teaching institutions. Further research into this concerning finding is needed.
SourceAvailable from: Mohammad H Jamal[Show abstract] [Hide abstract]
ABSTRACT: The widespread implementation of resident work hour restrictions has led to significant alterations in surgical training and the postgraduate educational experience. We evaluated the experience of surgical residency programs as reflected in the literature from 2008 onward in order to summarize current challenges and identify key areas in need of further research. We searched MEDLINE and EMBASE for English-language articles published from January 2008 to December 2011 related to work hour restrictions in surgical residency programs, including those pertaining to personal well-being, education and training, patient care, and faculty experiences. We retrieved 240 unique abstracts and included 24 studies in the current review. Of the 10 studies examining effects on operating room experience, 4 reported negative or mixed outcomes and 6 reported neutral outcomes, although non-compliance was demonstrated in 2 of these studies. Effects on surgical faculty perceptions were consistently reported as negative, while the effect on patient outcomes and professionalism were found to be neutral and unchanged. Further studies are needed to characterize operative experience at varying levels of training, particularly in the context of strict adherence to new work hours. Research that examines the effect of the work hour limitations on professionalism and non-operative educational activities, such as reading and simulation-based training, as well as sign-over practices, would also be of benefit.BMC Medical Education 12/2014; 14 Suppl 1:S14. DOI:10.1186/1472-6920-14-S1-S14 · 1.41 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Changes in resident duty hours in Europe and North America have had a major impact on the internal organizational dynamics of health care organizations. This paper examines, and assesses the impact of, organizational interventions that were a direct response to these duty hour reforms. The academic literature was searched through the SCOPUS database using the search terms "resident duty hours" and "European Working Time Directive," together with terms related to organizational factors. The search was limited to English-language literature published between January 2003 and January 2012. Studies were included if they reported an organizational intervention and measured an organizational outcome. Twenty-five articles were included from the United States (n = 18), the United Kingdom (n = 5), Hong Kong (n = 1), and Australia (n = 1). They all described single-site projects; the majority used post-intervention surveys (n = 15) and audit techniques (n = 4). The studies assessed organizational measures, including relationships among staff, work satisfaction, continuity of care, workflow, compliance, workload, and cost. Interventions included using new technologies to improve handovers and communications, changing staff mixes, and introducing new shift structures, all of which had varying effects on the organizational measures listed previously. Little research has assessed the organizational impact of duty hour reforms; however, the literature reviewed demonstrates that many organizations are using new technologies, new personnel, and revised and innovative shift structures to compensate for reduced resident coverage and to decrease the risk of limited continuity of care. Future research in this area should focus on both micro (e.g., use of technology, shift changes, staff mix) and macro (e.g., culture, leadership support) organizational aspects to aid in our understanding of how best to respond to these duty hour reforms.BMC Medical Education 12/2014; 14 Suppl 1:S4. DOI:10.1186/1472-6920-14-S1-S4 · 1.41 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Fuelled by concerns about resident health and patient safety, there is a general trend in many jurisdictions toward limiting the maximum duration of consecutive work to between 14 and 16 hours. The goal of this article is to assist institutions and residency programs to make a smooth transition from the previous 24- to 36-hour call system to this new model. We will first give an overview of the main types of coverage systems and their relative merits when considering various aspects of patient care and resident pedagogy. We will then suggest a practical step-by-step approach to designing, implementing, and monitoring a scheduling system centred on clinical and educational needs in the context of resident duty hour reform. The importance of understanding the impetus for change and of assessing the need for overall workflow restructuring will be explored throughout this process. Finally, as a practical example, we will describe a large, university-based teaching hospital network's transition from a traditional call-based system to a novel schedule that incorporates the new 16-hour duty limit.BMC Medical Education 12/2014; 14 Suppl 1:S18. DOI:10.1186/1472-6920-14-S1-S18 · 1.41 Impact Factor