The ACGME’s 2011 Changes to Resident Duty Hours: Are They an Unfunded Mandate on Teaching Hospitals?

Romano, Patrick S.; Volpp, Kevin G.

doi:10.1007/s11606-011-1936-x

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…30 As a result, the duty hour restrictions may have exacerbated the problem of work compression, with residents expected to complete the same amount of work as previous cohorts but in less total time. 31 Increased work compression has been associated with poorer clinical performance and decreased satisfaction among residents.…”

Section: Discussionmentioning

confidence: 99%

Effects of the 2011 Duty Hour Reforms on Interns and Their Patients

Sen¹,

Kranzler²,

Didwania³

et al. 2013

JAMA Intern Med

145

157

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Section: Discussionmentioning

confidence: 99%

Effects of the 2011 Duty Hour Reforms on Interns and Their Patients

Sen¹,

Kranzler²,

Didwania³

et al. 2013

JAMA Intern Med

145

157

View full text Add to dashboard Cite

“…Residency programs that violate these rules risk losing their accreditation, which has important financial ramifications. 2 These rules have been controversial, and programs have struggled to adapt (Romano and Volpp 2012). Duty-hour limits represent a significant change in the context and organization of work for residents.…”

Section: Dimensions Of Change In American Health Carementioning

confidence: 99%

Training for Efficiency

Szymczak

Bosk

2012

J Health Soc Behav

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Medical residency is a period of intense socialization with a heavy workload. Previous sociological studies have identified efficiency as a practical skill necessary for success. However, many contextual features of the training environment have undergone dramatic change since these studies were conducted. What are the consequences of these changes for the socialization of residents to time management and the development of a professional identity? Based on observations of and interviews with internal medicine residents at 3 training programs, we find that efficiency is both a social norm and strategy that residents employ to manage a workload for which the demand for work exceeds the supply of time available to accomplish it. We found that residents struggle to be efficient in the face of seemingly intractable “systems” problems. Residents work around these problems, and in doing so develop a tolerance for organizational vulnerabilities.

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“…Further-more, such changes are associated with significant cost burdens without additional funding available. 14,15 Given the significance of duty hour reforms, it is of vital importance that the immediate associations of these changes be evaluated. In this study, our objective was to evaluate the association of the 2011 ACGME duty hour reforms with mortality and readmissions among hospitalized Medicare patients during the first year after the reforms.…”

mentioning

confidence: 99%

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients

Patel

Volpp

Small

et al. 2014

JAMA

103

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IMPORTANCE Patient outcomes associated with the 2011 Accreditation Council for Graduate Medical Education (ACGME) duty hour reforms have not been evaluated at a national level. OBJECTIVE To evaluate the association of the 2011 ACGME duty hour reforms with mortality and readmissions. DESIGN, SETTING, AND PARTICIPANTS Observational study of Medicare patient admissions (6 384 273 admissions from 2 790 356 patients) to short-term, acute care, nonfederal hospitals (n = 3104) with principal medical diagnoses of acute myocardial infarction, stroke, gastrointestinal bleeding, or congestive heart failure or a Diagnosis Related Group classification of general, orthopedic, or vascular surgery. Of the hospitals, 96 (3.1%) were very major teaching, 138 (4.4%) major teaching, 442 (14.2%) minor teaching, 443 (14.3%) very minor teaching, and 1985 (64.0%) nonteaching. EXPOSURE Resident-to-bed ratio as a continuous measure of hospital teaching intensity. MAIN OUTCOMES AND MEASURES Change in 30-day all-location mortality and 30-day all-cause readmission, comparing patients in more intensive relative to less intensive teaching hospitals before (July 1, 2009–June 30, 2011) and after (July 1, 2011–June 30, 2012) duty hour reforms, adjusting for patient comorbidities, time trends, and hospital site. RESULTS In the 2 years before duty hour reforms, there were 4 325 854 admissions with 288 422 deaths and 602 380 readmissions. In the first year after the reforms, accounting for teaching hospital intensity, there were 2 058 419 admissions with 133 547 deaths and 272 938 readmissions. There were no significant postreform differences in mortality accounting for teaching hospital intensity for combined medical conditions (odds ratio [OR], 1.00; 95% CI, 0.96–1.03), combined surgical categories (OR, 0.99; 95% CI, 0.94–1.04), or any of the individual medical conditions or surgical categories. There were no significant postreform differences in readmissions for combined medical conditions (OR, 1.00; 95% CI, 0.97–1.02) or combined surgical categories (OR, 1.00; 95% CI, 0.98–1.03). For the medical condition of stroke, there were higher odds of readmissions in the postreform period (OR, 1.06; 95% CI, 1.001–1.13). However, this finding was not supported by sensitivity analyses and there were no significant postreform differences for readmissions for any other individual medical condition or surgical category. CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries, there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized in more intensive relative to less intensive teaching hospitals in the year after implementation of the 2011 ACGME duty hour reforms compared with those hospitalized in the 2 years before implementation.

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The ACGME’s 2011 Changes to Resident Duty Hours: Are They an Unfunded Mandate on Teaching Hospitals?

Cited by 10 publications

References 15 publications

Effects of the 2011 Duty Hour Reforms on Interns and Their Patients

Effects of the 2011 Duty Hour Reforms on Interns and Their Patients

Training for Efficiency

Association of the 2011 ACGME Resident Duty Hour Reforms With Mortality and Readmissions Among Hospitalized Medicare Patients

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