Prolonged hospital stay and the resident duty hour rules of 2003

Med Care. 2009 Dec;47(12):1191-200. doi: 10.1097/MLR.0b013e3181adcbff.


Background: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care.

Objective: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge.

Research design: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site.

Subjects: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005.

Measures: Prolonged length of stay.

Results: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures.

Conclusions: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

Publication types

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

MeSH terms

  • Accreditation
  • Aged
  • Aged, 80 and over
  • Female
  • Hospital Mortality / trends
  • Hospitals, Teaching / statistics & numerical data
  • Humans
  • Internship and Residency / organization & administration*
  • Length of Stay / statistics & numerical data*
  • Male
  • Medicare / statistics & numerical data
  • Personnel Staffing and Scheduling / statistics & numerical data*
  • Quality of Health Care / organization & administration
  • United States
  • United States Department of Veterans Affairs / statistics & numerical data