Inpatient safety outcomes following the 2011 residency work-hour reform

J Hosp Med. 2014 Jun;9(6):347-52. doi: 10.1002/jhm.2171. Epub 2014 Feb 22.


Background: The impact of the 2011 residency work-hour reforms on patient safety is not known.

Objective: To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center.

Design: Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes.

Patients: All adult patients discharged from general medicine services from July 2008 through June 2012.

Measurements: Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index.

Results: Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes.

Conclusions: In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Internship and Residency / legislation & jurisprudence
  • Internship and Residency / standards*
  • Male
  • Middle Aged
  • Patient Safety / standards*
  • Personnel Staffing and Scheduling / legislation & jurisprudence
  • Personnel Staffing and Scheduling / standards*
  • Retrospective Studies
  • Workload / standards*