An automated electronic system identified patients with acute lung injury with high sensitivity and specificity in diverse intensive care units of a large academic medical center. Further studies are needed to evaluate the effect of automated prompts that such a system can initiate on the use of lung protective ventilation in patients with acute lung injury.

BACKGROUND The United States instituted restrictions on resident work-hours in July 2003. The clinical impact of this reform on critically ill patients is unknown. OBJECTIVE We sought to examine the association of the resident work-hours reform with mortality for patients in medical and surgical intensive care units (ICUs). DESIGN We conducted a retrospective cohort study, comparing mortality trends before and after July 1, 2003, in teaching and non-teaching hospitals. SETTING AND PATIENTS The study included 230,151 adult patients admitted to 104 different ICUs at 40 hospitals participating in the APACHE IV clinical information system from July 1, 2001, to June 30, 2005. MEASUREMENTS AND MAIN RESULTS The primary exposure was the date of admission, relative to the implementation of the work-hours regulations. The primary outcome was in-hospital mortality; a secondary outcome was ICU mortality. The analysis included 79,377 patients in 12 academic hospitals; 73,580 patients in 12 community hospitals with residents; and 77,194 patients in 16 non-teaching hospitals. Risk-adjusted mortality improved in hospitals of all teaching levels during the study period. There were no significant differences in the mortality trends between hospitals of different teaching intensities, as demonstrated by non-significant interaction between time and teaching status (global test of interaction p=0.56). CONCLUSIONS There was a decrease in in-hospital mortality in ICU patients during the years of observation. This decrease was not associated with hospital teaching status, suggesting no net positive or negative association of the resident work-hours regulations with a major patient-centered outcome.