Effect of 16-Hour Duty Periods on Patient Care and Resident Education

Abstract

OBJECTIVE:To measure the effect of duty periods no longer than 16 hours on patient care and resident education. PATIENTS AND METHODS:As part of our Educational Innovations Project, we piloted a novel resident schedule for an inpatient service that eliminated shifts longer than 16 hours without increased staffing or decreased patient admissions on 2 gastroenterology services from August 29 to November 27, 2009. Patient care variables were obtained through medical record review. Resident well-being and educational variables were collected by weekly surveys, end of rotation evaluations, and an electronic card-swipe system. RESULTS:Patient care metrics, including 30-day mortality, 30-day readmission rate, and length of stay, were unchanged for the 196 patient care episodes in the 5-week intervention month compared with the 274 episodes in the 8 weeks of control months. However, residents felt less prepared to manage cross-cover of patients (P=.006). There was a nonsignificant trend toward decreased perception of quality of education and balance of personal and professional life during the intervention month. Residents reported working fewer weekly hours overall during the intervention (64.3 vs 68.9 hours; P=.40), but they had significantly more episodes with fewer than 10 hours off between shifts (24 vs 2 episodes; P=.004).CONCLUSION: Inpatient hospital services can be staffed with residents working shifts less than 16 hours without additional residents. However, cross-cover of care, quality of education, and time off between shifts may be adversely affected.

Accuracy of Residents' Retrospective Perceptions of 16-Hour Call Admitting Shift Compliance and Characteristics

“…[1][2][3] After implementation of the standards in 2003 and revision in 2011, numerous studies have evaluated their impact on patient safety, education, and fatigue, all resulting in systematic changes to achieve compliance based on survey data. [4][5][6][7][8][9][10][11] Most evaluations of compliance rely on resident retrospective self-reports, and the accuracy of such reports has been questioned. 4,12,13 The ACGME administers the Resident-Fellow Survey once per year between January and June; it requires residents to retrospectively answer questions on shift-length compliance and workload characteristics.…”

Redesign of an Internal Medicine Ward Rotation: Operational Challenges and Outcomes

“…3 Our increased conference attendance may be because, with the addition of 2 teams, our average patient census per team fell by about 30% (from 13.1 to 9.1). Indeed, a lower patient census has been associated with increased resident participation in educational activities.…”

“…The 2003 ACGME duty hour limits allowed 24 hours of continuous duty, plus 6 hours for educational activities and transition of care for all residents. Program directors and trainees have expressed concerns that the 2011 limits will negatively affect patient care, resident education, and faculty satisfaction, [2][3][4][5][6] whereas reports on the educational impact of the 2003 ACGME duty hour restrictions have been mixed. [7][8][9][10][11][12][13][14] A recent review of the effects of duty hours did not include specific analysis of general internal medicine ward experiences.…”

Duty Hours: Where Do We Go From Here?

“…I believe we need information from many sources to guide any subsequent changes in the regulations. This should include qualitative and descriptive studies about what works and what does not work, like the report in this issue of the Proceedings by McCoy et al 2 Our inquiries should address questions such as: What effect do resident duty hour limits have on the workload and learning of residents and on medical students? Do duty hour limits change the workload and teaching of attending physicians?…”

“…1,2 These articles will prompt discussion among resident physicians and their faculty and evoke memories for those of us who completed residency training in an earlier era. In this regard, I am no exception.…”