Impact of Extended Duty Hours on Perceptions of Care and Objective Patient Outcomes

Abstract

ObjectiveIn 2017, interns were permitted to work continuously for up to 28 hours at a time, a reversal from the previously mandated 16-hour limit. Our objective was to evaluate perceptions of care and patient outcomes on an extended (28-hour) compared with a limited (16-hour) duty-hour system on identical interdisciplinary teams.MethodsSixty-two interns, 27 residents, 28 attendings, and 449 patients participated. Patients completed surveys assessing their satisfaction. Anonymous weekly surveys were obtained from interns, residents, and attendings evaluating perceptions of intern tiredness, overall satisfaction, and performance. Nursing surveys evaluated intern and medical team performance. Objective outcome measures, including intensive care unit transfers, length of stay, readmissions, mortality, and complications, were assessed through a retrospective, blinded chart review.ResultsPatients reported similar satisfaction in care. Extended duty-hour interns reported significantly decreased familiarity with their patients, decreased ability to conduct physical exams on new patients, increased tiredness, and decreased overall satisfaction. Residents overseeing extended-duty interns reported significantly decreased quality in intern presentations and overall quality of teaching, and increased perception of intern tiredness and increased incorrect orders. Attending physicians reported significantly improved quality of new patient presentations by extended duty-hour interns. No significant differences in patient objective outcome measures were noted.ConclusionsExtended intern duty hours do not affect patient’s satisfaction with their care. Although interns in the extended duty-hour system reported significantly increased fatigue and decreased overall satisfaction and residents’ perceived increases in incorrect intern orders in the extended duty-hour system, there were no detrimental effects on patient safety.

Urology Residents’ Perspectives on the In-House On-Call Systems: A Study in an Accredited Academic Center

“…Regarding the effect of ACGME duty hours limitations 14 on patient safety and QoL provided by residents, several studies have reported that adherence to ACGME rule is associated with improved patient safety, 35 – 37 while others reported no change or even decreased patient safety. 38 – 40 McGahan et al found that patient-related outcomes are comparable between the 24-hour on-call system and the night float system, 41 while Mohapatra et al reported that the night float system is associated with better overall patient care, which could be attributed to the shorter continuous duties. 11 Although the finding of better patient care found in the night float systems can be expanded to a 12-hour on-call system due to the similar duties duration.…”

Residencias médicas del Hospital Británico de Buenos Aires: pasado, presente y futuro

“…El cambio en la mortalidad a los 30 días (resultado principal) entre los pacientes de los programas flexibles (12.5% en el año de prueba frente a 12.6% en el año previo a la prueba) no fue inferior al de los programas estándar (12.2% en el año de prueba frente a 12.6% en el año de prueba). Permitir que los directores de programas tengan flexibilidad para ajustar los horarios de trabajo de los residentes no afectó negativamente la mortalidad a los 30 días ni varios otros resultados medidos de la seguridad del paciente 76,77 . Por otro lado, la duración del sueño en los programas flexibles no fue inferior a la de los programas estándar 78 .…”