Shorter resident work hours did not impact quality of care, study finds

After examining 30-day mortality and 30-day readmissions among Medicare patients from 2000-2012, researchers report that first-year internists who trained before, during and after ACGME’s 80-hour weekly cap on resident work hours had similar outcomes.

Their findings, published last week in BMJ, suggest that the limit on resident work hours, implemented in 2003, has not affected the quality of care provided by fully trained internists.

The study also looked at inpatient spending and did not find a statistically significant difference in the costs of care provided by internists who trained before and after the work hour reforms.

What researchers looked at

Researchers examined the records of more than 485,000 Medicare patients who had been hospitalized between 2000-2006 and 2007-2012 and cared for by first-year internists. They wanted to compare treatment from physicians who had partial or no exposure to work hour reforms with those who completed all their residency training with work hour limits.

Researchers also examined a control group of internists in their tenth year of practice to account for general trends in hospital care. An adjusted difference-in-difference analysis found no statistically significant variation between the 2000-2006 and 2007-2012 cohorts in any of the outcomes measured.

A much-discussed policy

“The potential impact of resident work hour reform on the competency of physicians completing residency has been much discussed in medical education,” the study’s authors wrote. “Because reductions in work hours and increased shift work could theoretically lead trainees to be less prepared for independent practice, understanding the implications of work hour reforms on the quality and costs of care provided by physicians entering independent practice is important.”

This is the first national study examining the effect of residency work hour reforms on the performance of physicians after they complete residency, according to the study.

ACGME implemented an 80-hour cap on resident work hours in July 2003 amid concerns about medical errors resulting from resident fatigue, the study noted. The 2003 cap restricted all residents to 80 hours of work per week, limited shifts to 24 hours (not including time for patient care handoffs), limited in-hospital call to every third night, and required residents to have four days off every 28 days.

A second reform, in 2011, capped shift lengths to 16 hours for interns and 28 hours for more advanced trainees. In 2017, a third reform allowed interns to complete longer shifts.

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