Changes in outcomes for internal medicine inpatients after work-hour regulations

Ann Intern Med. 2007 Jul 17;147(2):97-103. doi: 10.7326/0003-4819-147-2-200707170-00163. Epub 2007 Jun 4.


Background: Limits on resident work hours are intended to reduce fatigue-related errors, but may raise risk by increasing transfers of responsibility for patients.

Objective: To examine changes in outcomes for internal medicine patients after the implementation of work-hour regulations.

Design: Retrospective cohort study.

Setting: Urban, academic medical center.

Patients: 14,260 consecutive patients discharged from the teaching (housestaff) service and 6664 consecutive patients discharged from the nonteaching (hospitalist) service between 1 July 2002 and 30 June 2004.

Measurements: Outcomes included intensive care unit utilization, length of stay, discharge disposition, 30-day readmission rate to the study institution, pharmacist interventions to prevent error, drug-drug interactions and in-hospital death.

Results: The teaching service had net improvements in 3 outcomes. Relative to changes experienced by the nonteaching service, the rate of intensive care unit utilization decreased by 2.1% (95% CI, -3.3% to -0.7%; P = 0.002), the rate of discharge to home or rehabilitation facility versus elsewhere improved by 5.3% (CI, 2.6% to 7.6%; P < 0.001), and pharmacist interventions to prevent error were reduced by 1.92 interventions per 100 patient-days (CI, -2.74 to -1.03 interventions per 100 patient-days; P < 0.001). Teaching and nonteaching services had similar changes over time in length of stay, 30-day readmission rate, and adverse drug-drug interactions. In-hospital death was uncommon in both groups, and change over time was similar in the 2 groups.

Limitations: The study was a retrospective, nonrandomized design that assessed a limited number of outcomes. Teaching and nonteaching cohorts may not have been affected similarly by secular trends in patient care.

Conclusions: After the implementation of work-hour regulations, 3 of 7 outcomes improved for patients in the teaching service relative to those in the nonteaching service. The authors found no evidence of adverse unintended consequences after the institution of work-hour regulations.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hospitalists / standards
  • Hospitals, Teaching / standards*
  • Humans
  • Inpatients
  • Internal Medicine / education
  • Internal Medicine / standards*
  • Internship and Residency / legislation & jurisprudence*
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care*
  • Patient Care / standards*
  • Personnel Staffing and Scheduling / legislation & jurisprudence*
  • Retrospective Studies
  • United States