study explores effectiveness of restrictions on resident work hours ii

Last time, we discussed how past studies have found the work-hour restrictions for medical residents, introduced by the Accreditation Council for Graduate Medical Education back in 2011 as a means of reducing potential fatigue-related medical errors, had little impact on outcomes among general surgical patients.

We also touched on how a recently published study by researchers with the American College of Surgeons found largely the same results among surgical patients who underwent more specialized procedures. In today’s post, we’ll take a more in-depth look at this study.

How exactly did the ACS researchers structure their study?

The researchers set out to determine what difference, if any, the 2011 work-hour restrictions for residents had for those patients who underwent a surgical procedure in one of five specialties — neurosurgery, vascular surgery, urology, obstetrics/gynecology and orthopedic surgery. They did this by examining patient outcomes in the year before the restrictions went into effect and the two years after the restrictions went into effect.

What did they determine?

After identifying thousands of eligible surgical patients from teaching and nonteaching hospitals and adjusting for various factors, the researchers determined there was no statistically significant difference in patient outcomes (i.e., mortality rates and incidents of serious postoperative complications within 30 days of a procedure) before and after the introduction or work-hour restrictions for residents.

Was this the only noteworthy finding of the ACS’ study?

No. The researchers also argued at least one aspect of the 2011 work-hour restrictions — specifically the mandate prohibiting residents working 24-hour shifts from spending any more than four hours conducting patient handoffs — may actually be compromising the delivery of medical care and, by extension, jeopardizing patient safety.

That’s because it is actually resulting in residents having to complete more patient handoffs in a narrower timeframe. This is problematic, of course, as transfers of patient care have long been recognized as “one of the most common preventable causes of serious patient harm events,” as harried physicians often fail to communicate all of the important patient information to the new physician.

What did the ACS researchers conclude as to what should be done going forward?

The researchers called for additional research, such as clinical trials, to help determine the best possible model for resident work hours.

It will be interesting to see what the ACGME has to say in response to this study and whether it agrees to revisit the work-hour restrictions for residents.

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