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

doi:10.1097/MLR.0b013e31819a588f

. 2009 Jul;47(7):723-31.

doi: 10.1097/MLR.0b013e31819a588f.

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

Amy K Rosen¹, Susan A Loveland, Patrick S Romano, Kamal M F Itani, Jeffrey H Silber, Orit O Even-Shoshan, Michael J Halenar, Yun Teng, Jingsan Zhu, Kevin G Volpp

Affiliations

PMID: 19536029
PMCID: PMC3893754
DOI: 10.1097/MLR.0b013e31819a588f

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

Amy K Rosen et al. Med Care. 2009 Jul.

. 2009 Jul;47(7):723-31.

doi: 10.1097/MLR.0b013e31819a588f.

Authors

Amy K Rosen¹, Susan A Loveland, Patrick S Romano, Kamal M F Itani, Jeffrey H Silber, Orit O Even-Shoshan, Michael J Halenar, Yun Teng, Jingsan Zhu, Kevin G Volpp

Affiliation

¹ Center for Health Quality, Outcomes, and Economic Research, VA Center of Excellence, 200 Springs Road (152), Bedford, MA 01730, USA. akrosen@bu.edu

PMID: 19536029
PMCID: PMC3893754
DOI: 10.1097/MLR.0b013e31819a588f

Abstract

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.

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Figures

**Figure 1**
Changes Over Time in Unadjusted PSI Composite Rates in More vs. Less Teaching-Intensive Hospitals

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Comment in

Fatigue, resident work hours, and safety.
Bates DW. Bates DW. Med Care. 2009 Jul;47(7):711-3. doi: 10.1097/MLR.0b013e3181adc2b9. Med Care. 2009. PMID: 19536000 Review. No abstract available.

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References

1. [Accessed April 8, 2008];Resident duty hours language: final requirements [Accreditation Council for Graduate Medical Education web site] Available at: http://acgme.org.
1. Shetty KD, Bhattacharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med. 2007;147(2):73–80. - PubMed
1. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):975–983. - PubMed
1. Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141(11):851–857. - PubMed
1. Jagsi R, Weinstein DF, Shapiro J, et al. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours and patient safety. A study of resident experiences and perceptions before and after hours reductions. Arch Intern Med. 2008;168(5):493–500. - PubMed

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[1] [Accessed April 8, 2008];Resident duty hours language: final requirements [Accreditation Council for Graduate Medical Education web site] Available at: http://acgme.org.

[2] [Accessed April 8, 2008];Resident duty hours language: final requirements [Accreditation Council for Graduate Medical Education web site] Available at: http://acgme.org.

[3] Shetty KD, Bhattacharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med. 2007;147(2):73–80. - PubMed

[4] Shetty KD, Bhattacharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med. 2007;147(2):73–80. - PubMed

[5] Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):975–983. - PubMed

[6] Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):975–983. - PubMed

[7] Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141(11):851–857. - PubMed

[8] Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: effects of resident work hours on patient safety. Ann Intern Med. 2004;141(11):851–857. - PubMed

[9] Jagsi R, Weinstein DF, Shapiro J, et al. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours and patient safety. A study of resident experiences and perceptions before and after hours reductions. Arch Intern Med. 2008;168(5):493–500. - PubMed

[10] Jagsi R, Weinstein DF, Shapiro J, et al. The Accreditation Council for Graduate Medical Education’s limits on residents’ work hours and patient safety. A study of resident experiences and perceptions before and after hours reductions. Arch Intern Med. 2008;168(5):493–500. - PubMed

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

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

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