Impact of the 2011 ACGME resident duty hour reform on hospital patient experience and processes-of-care

BMJ Qual Saf. 2016 Dec;25(12):962-970. doi: 10.1136/bmjqs-2015-004794. Epub 2015 Dec 30.


Introduction: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) expanded restrictions on resident duty hours. While studies have shown no association between these restrictions and improved outcomes, process-of-care and patient experience measures may be more sensitive to resident performance, and thus may be impacted by duty hour policies. The objective of this study was to evaluate the association between the 2011 resident duty hour reform and measures of processes-of-care and patient experience.

Methods: Hospital Consumer Assessment of Healthcare Providers and Systems survey data and process-of-care scores were obtained from the Centers for Medicare and Medicaid Services Hospital Compare website for 1 year prior to (1 July 2010 to 30 June 2011) and 1 year after (1 July 2011 to 30 June 2012) duty hour reform implementation. Using a difference-in-differences model, non-teaching and teaching hospitals were compared before and after the 2011 reform to test the association of this policy with changes in process-of-care and patient experience measure scores.

Results: Duty hour reform was not associated with a change in the five patient experience measures evaluated, including patients rating a hospital 9 or 10 (coefficient -0.003, 95% CI -0.79 to 0.79) or stating they would 'definitely recommend' a hospital (coefficient -0.28, 95% CI -1.01 to 0.44). For all 10 process-of-care measures examined, such as antibiotic timing (coefficient -0.462, 95% CI -1.502 to 0.579) and discontinuation (0.188, 95% CI -0.529 to 0.904), duty hour reform was not associated with a change in scores.

Conclusions: The 2011 ACGME duty hour reform was not associated with improvements in process-of-care and patient experience measures. These data should be considered when considering reform of resident duty hour policies.

Keywords: Duty hours; Graduate medical education; Patient safety; Quality improvement.

MeSH terms

  • Hospitals, Teaching / standards
  • Humans
  • Internship and Residency / standards*
  • Patient Safety / statistics & numerical data*
  • Patient Satisfaction*
  • Personnel Staffing and Scheduling / standards*
  • Process Assessment, Health Care
  • Quality Indicators, Health Care
  • Quality of Health Care / standards*
  • United States