Patient Outcomes when Housestaff Exceed 80 Hours per Week

Abstract

Purpose It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigate whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work greater than eighty hours per week Methods We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether or not the patient was admitted by housestaff who have worked more than eighty hours a week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, ICU transfer rate, and 30-day readmission rate. Results We identified 4,767 hospitalizations by 3,450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than eighty hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs. 16.7%, p = 0.031) for patients admitted by housestaff working more than eighty hours a week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs. 4.66 days, p = 0.048) and rate of ICU transfer (3.18% vs. 2.38%, p = 0.029). There was no statistically significant difference in 30-day readmission rate (13.7% vs. 12.8%, p = 0.395), or in-hospital mortality rate (3.18% vs. 2.42%, p = 0.115).There was no correlation with team census on admission and patient outcomes. Conclusions Patients taken care of by housestaff working more than eighty hours a week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.

Long Working Hour Related Medical Errors and Patient Outcomes among Physicians: A Systematic Review

“…Participant residents were unable to be independently blinded from the knowledge to the exposure state. Besides, Anderson et al 7 collected data via self-reporting when there is record linage in Ouyang et al, 6 Yahoubian et al 8 and Bhavsar et al 9 The follow-up was long enough for the outcome to be visible in the 4 cohorts. On the other hand, no statement of the adequacy of the follow-up was noted.…”

The 2017 ACGME Common Work Hour Standards: Promoting Physician Learning and Professional Development in a Safe, Humane Environment

“…19,20 This standard currently is widely accepted by the medical education community. The community also has learned that programs that regularly schedule residents and fellows to work 80 hours per week and permit trainee flexibility are likely to exceed 80 weekly hours.…”

“…Trainees working beyond 80 hours has been found detrimental to safe and effective care. 19 Optimal scheduling approaches need to limit scheduled work to fewer than 80 hours to enable residents to remain beyond those scheduled periods when indicated by patient need or desired from an educational perspective.…”

Electronic Health Record Use among Ophthalmology Residents while on Call

“…As evidenced previously, these methods can be used to roughly estimate work hours and educational exposure of resident physicians. There have been several studies focused on addressing these goals in the field of internal medicine, [35][36][37] but ongoing work is needed to apply these methods to surgical specialties such as ophthalmology, where programs are smaller and residents often take home call to cover multiple clinical sites. Other foreseeable applications of EHR audit log data could be to identify programs violating work-hour restrictions or even to better inform evolving work-hour policies in the future.…”