Association between adaptations to ACGME duty hour requirements, length of stay, and costs

Sleep. 2013 Feb 1;36(2):245-8. doi: 10.5665/sleep.2382.


Study objective: To determine whether adaptations to comply with Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements are associated with changes in total cost and length of stay.

Design: Retrospective, interrupted time-series cohort study using concurrent control patients.

Setting: UCSF Benioff Children's Hospital, San Francisco, CA.

Patients: Inpatients newborn to 18 y on the primary pediatrics medical-surgical unit. Medical patients were studied before and after an intervention, and surgical patients served as a concurrent control group.

Intervention: Pediatrics trainees' work schedules were changed from those that relied on prolonged call shifts to those primarily based on shorter day shifts and night shifts.

Results: We detected significant relative reductions in length of stay but not in total cost. When the analysis was limited to the subset of patients who did not receive intensive care unit care, length of stay decreased by 18% and total cost decreased by 10%. We did not detect similar changes in the control group.

Conclusions: A trainee staffing model that included shorter shifts as consistent with current ACGME duty hour requirements was associated with reduced length of stay and total costs for patients not in the intensive care unit.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Education, Medical, Graduate / standards
  • Education, Medical, Graduate / statistics & numerical data
  • Female
  • Hospital Costs / statistics & numerical data*
  • Hospitals, Pediatric / economics
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Infant, Newborn
  • Internship and Residency / standards
  • Internship and Residency / statistics & numerical data*
  • Length of Stay / statistics & numerical data*
  • Male
  • Patient Readmission / statistics & numerical data
  • Pediatrics / education
  • Pediatrics / statistics & numerical data
  • Personnel Staffing and Scheduling / standards
  • Personnel Staffing and Scheduling / statistics & numerical data*
  • Retrospective Studies
  • Work Schedule Tolerance