SOURCES: Mitesh Patel, M.D., assistant professor, medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Karl Bilimoria, M.D., assistant professor, surgery, Northwestern University Feinberg School of Medicine, Chicago; James Arrighi, M.D., associate professor, medicine, Brown University, Providence, R.I.; Dec. 10 2014, Journal of the American Medical Association
TUESDAY, Dec. 9, 2014 (HealthDay News) -- Cutting medical residents' work hours hasn't reduced death rates, hospital readmission rates or outcomes of surgery, two new studies find.
"The work-hour restrictions have been controversial because there have been questions whether they are positive or negative," said Dr. James Arrighi, an associate professor of medicine at Brown University in Providence, R.I. Arrighi is also the co-author of an editorial accompanying the new studies in the Dec. 10 issue of the Journal of the American Medical Association.
In 2003, the Accreditation Council for Graduate Medical Education reduced intern and resident work hours to no more than 80 hours a week. In 2011, that rule was refined from no more than 30 consecutive hours to no more than 16 hours for first-year residents (interns) and 24 hours for residents, plus an additional four hours for transferring care and taking part in educational activities, according to background information in the study from the University of Pennsylvania.
The initial changes were made out of concern that tired doctors-in-training might make more mistakes. The 2011 changes were made with the belief that medical education had suffered and that patient safety and outcomes might have been put at risk during care transitions, the study explained.
"Overall, the duty hour restrictions in themselves haven't resulted in a notable improvement in patient safety or quality of care or patient outcome," Arrighi said.
In the first study, a team lead by Dr. Mitesh Patel, an assistant professor of medicine at the University of Pennsylvania Perelman School of Medicine, found that the 2011 reforms hadn't reduced deaths or readmissions or improved patient safety among hospitalized Medicare patients.
These reforms may have made the situation worse by disrupting the continuity of care, Patel said.
"It's important that we balance tradeoffs between reducing resident fatigue and improving patient care," he said.
To reach these conclusions, Patel's group analyzed Medicare data on more than 6 million admissions at over 3,000 hospitals. The admissions were for conditions such as heart attack, stroke, stomach bleeding, heart failure, or conditions needing general, orthopedic or vascular surgery, according to the study.
In the second study, Dr. Karl Bilimoria, an assistant professor of surgery at Northwestern University Feinberg School of Medicine in Chicago, and colleagues found that the 2011 reforms did not result in significant changes in the rates of deaths or serious illness in general surgery patients during the first two years after the reforms were in place.
On the plus side, the study found that resident test scores and scores on medical board exams did not change significantly from 2010 to 2013, Bilimoria said.
Bilimoria said that although patient outcomes or scoring on tests did not get worse, they didn't get better, either.
He would keep the 80-hour workweek, but would like to see the other changes rescinded.
"We think that these restrictions are limiting continuity of care and hurting care," he said. "In absence of an improvement in outcomes, we would suggest that these rules are not necessary. They should be repealed."
For this study, researchers examined general surgery outcomes of more than 200,000 patients from 23 teaching and 31 non-teaching hospitals. They looked at the two years before and two years after the 2011 reform, according to the study.
Arrighi thinks that work-hour restrictions are only one part in improving the health care system. "You have to address multiple variables, and work hours is only one."
"It's not just duty hours. It's what supervision our trainees are getting: how you teach them to recognize fatigue. How you ensure hospitals have quality improvement programs. And how we teach our trainees to get involved in these programs," he said.
Arrighi added that two studies are under way comparing the 2011 duty hour rules with no limits except the 80-hour week and some days off and being on call only every other night. He hopes these studies will be the definitive answer to how work schedules affect patient care.
For more information on patient safety, visit the U.S. National Library of Medicine.