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Outcomes not affected by increased work hours

Residency Program Insider, February 5, 2016

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The first study looking at if residents’ increased duty hours affected patient outcomes has been released and it shows that the justification for work limits may not be there. In an analysis of nearly 140,000 patients, less restrictive duty hour policies (i.e., number of consecutive hours worked and time off between shifts) did not lead to an increase in death or serious complications.

The study covered 4,330 residents across 115 general surgery programs in the 2014-2015 academic year. Half of the group followed the current ACGME duty hour rules. The other half still had to follow the 80-hour work week rule, but first year residents were allowed to exceed the 16-hour shift limit and other residents the 28-hour shift limit.

With the flexible schedule, the study found that surgeons in training were half as likely to miss an operation, leave one, or hand off a patient as their counterparts following the current rules. The result was improved continuity of care and education, the researchers found.

Also, residents in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality or well-being. Residents under flexible policies were less likely than those under standard policies to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education but were more likely to perceive negative effects on personal activities. There were no significant differences between study groups in resident-reported perception of the effect of fatigue on personal or patient safety.

Source: New England Journal of Medicine

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