Limiting Residents' Hours Has Little Impact on Patient Mortality
Tuesday, September 4, 2007; 12:00 AM
TUESDAY, Sept. 4 (HealthDay News) -- Limiting the hours that medical residents can work has made no difference in death rates among Medicare patients in the first two years since the new rules were instituted, a new study found.
The reform was associated with improvements in mortality for patients with common medical conditions at VA hospitals, however.
"We can say conclusively that the duty-hour regulations did not worsen patient mortality. There was a lot of concern about that, and we can conclusively say that's not the case," said Dr. Kevin G. Volpp, staff physician and core faculty member at the Center for Health Equity, Research and Promotion at the Philadelphia Veterans Affairs Medical Center. "We can also say that there's some evidence of benefit in terms of mortality outcomes."
The researchers still don't know if there are benefits in other measures besides mortality, and what impact the changes are having on educational results.
"The big question is how regulating work hours will affect the quality of training of the next generation of physicians who will be taking care of all of us for the next several decades," said Volpp, an assistant professor of medicine and health care systems at the University of Pennsylvania School of Medicine and Wharton School of Business. "That's the question no one really knows the answer to."
Both studies are published in the Sept. 5 issue of theJournal of the American Medical Association, a theme issue on medical education. Volpp was lead author of both papers.
Starting July 1, 2003, the Accreditation Council for Graduate Medical Education, which evaluates and accredits U.S. medical school residency programs, limited the maximum working hours for residents to 80 a week.
"Before, residents commonly worked 90 to 120 hours a week and sometimes 60 or 72 hours in a row," Volpp said.
The action was taken in response to concerns that lengthy hours left residents tired and prone to making dangerous medical errors.
But others have expressed concern that decreased continuity of care would have negative effects on patient outcomes.
For the first study, Volpp and his colleagues looked at more than 8.5 million Medicare patients admitted to 3,321 teaching hospitals from July 1, 2000, to June 30, 2005. The patients had been diagnosed with heart attack, congestive heart failure, gastrointestinal bleeding or stroke, or were undergoing different types of surgery.
Overall, the changes in work hours made no difference in the odds of dying.