Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients

Med Care. 2009 Jul;47(7):723-31. doi: 10.1097/MLR.0b013e31819a588f.


Objective: Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms.

Research design: Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site.

Measures: Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites.

Results: Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year.

Conclusions: Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Continuity of Patient Care / statistics & numerical data
  • Factor Analysis, Statistical
  • Health Care Reform / organization & administration
  • Health Services Research
  • Hospitals, Teaching / organization & administration
  • Hospitals, Veterans / organization & administration
  • Humans
  • Internship and Residency / organization & administration*
  • Logistic Models
  • Medical Errors / prevention & control
  • Medical Errors / statistics & numerical data
  • Medicare / organization & administration
  • Quality Indicators, Health Care / statistics & numerical data*
  • Risk Adjustment / statistics & numerical data
  • Safety Management / organization & administration*
  • Severity of Illness Index
  • United States
  • United States Department of Veterans Affairs / organization & administration
  • Workload / statistics & numerical data*