Do Regulations Limiting Residents' Work Hours Affect Patient Mortality?

Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Journal of General Internal Medicine (Impact Factor: 3.45). 02/2004; 19(1):1-7. DOI: 10.1111/j.1525-1497.2004.30336.x
Source: PubMed


To conduct a statewide analysis of the effect of New York's regulations, limiting internal medicine and family practice residents' work hours, on patient mortality.
Retrospective study of inpatient discharge files for 1988 (before the regulations) and 1991 (after the regulations).
Adult patients discharged from New York teaching hospitals (170214) and nonteaching hospitals (143,455) with a principal diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia, for the years 1988 and 1991 (periods before and after Code 405 regulations went into law). Patients from nonteaching hospitals served as controls.
In-hospital mortality.
Combined unadjusted mortality for congestive heart failure, acute myocardial infarction, and pneumonia patients declined between 1988 and 1991 in both teaching (14.1% to 13.0%; P =.0001) and nonteaching hospitals (14.0% to 12.5%; P =.0001). Adjusted mortality also declined between 1988 and 1991 in both teaching (odds ratio [OR], death 1991/1988, 0.868; 95% confidence interval [CI], 0.843 to 0.894; P =.0001) and nonteaching hospitals (OR, death 1991/1988, 0.853; 95% CI, 0.826 to 0.881; P =.0001). This beneficial trend toward lower mortality over time was nearly identical between teaching and nonteaching hospitals (P =.4348).
New York's mandated limitations on residents' work hours do not appear to have positively or negatively affected in-hospital mortality from congestive heart failure, acute myocardial infarction, or pneumonia in teaching hospitals.

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Available from: David L Howard, Feb 17, 2014
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    • "The impact of regulatory oversight is mixed and would benefit from STSA input. For example, regulatory requirements for the healthcare industry have not been evaluated universally with respect to the most basic measures such as patient mortality (see, for example, Howard et al. (2004)). Medical device oversight for complex medical devices has yet to determine if increasing device complexity is associated with decreased reliability (see for example Maisel et al. (2006)). "
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    ABSTRACT: Given the complexity of health care and the 'people' nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.
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    • "A study conducted over a decade ago, after New York State implemented duty hour reductions, found delays in test ordering and an increase in hospital complications.5 More recent reviews, moreover, found no evidence of improved mortality6 or patient safety7 after duty hours were reduced. Taken together, these studies suggest that resident errors may be due to factors other than long duty hours, but few data exist regarding residents’ perceptions of how errors are produced or how duty hour reductions may have affected these contributing factors. "
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    ABSTRACT: Resident duty hour limitations aim, in part, to reduce medical errors. Residents' perceptions of the impact of duty hours on errors are unknown. To determine residents' self-reported contributing factors, frequency, and impact of hours worked on suboptimal care practices and medical errors. Cross-sectional survey. 164 Internal Medicine Residents at the University of California, San Francisco. Residents were asked to report the frequency and contributing factors of suboptimal care practices and medical errors, and how duty hours impacted these practices and aspects of resident work-life. One hundred twenty-five residents (76%) responded. The most common suboptimal care practices were working while impaired by fatigue and forgetting to transmit information during sign-out. In multivariable models, residents who felt overwhelmed with work (p = 0.02) and who reported spending >50% of their time in nonphysician tasks (p = 0.002) were more likely to report suboptimal care practices. Residents reported work-stress (a composite of fatigue, excessive workload, distractions, stress, and inadequate time) as the most frequent contributing factor to medical errors. In multivariable models, only engaging in suboptimal practices was associated with self-report of higher risk for medical errors (p < 0.001); working more than 80 hours per week was not associated with suboptimal care or errors. Our findings suggest that administrative load and work stressors are more closely associated with resident reports of medical errors than the number of hours work. Efforts to reduce resident duty hours may also need to address the nature of residents' work to reduce errors.
    Full-text · Article · Feb 2007 · Journal of General Internal Medicine
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    • "Current data as regard to the utility of limiting residents' work hours in reducing medical errors are conflicting (e.g. Lockley et al., 2004; Howard et al., 2004). CDI 11,5 The present study also has some limitations. "
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