New Requirements for Resident Duty Hours

Philibert, Ingrid; Friedmann, Paul; Williams, W. T.

doi:10.1001/jama.288.9.1112

Cited by 466 publications

(196 citation statements)

References 5 publications

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“…1 Resident well-being and patient safety were the main concerns relating to the excessive duty hours that residents sometimes worked prior to the 2003 changes. Even after these modifications, concerns remained about how compliant residents were with the duty hour rules, 2 and one rigorous study suggested that further reductions in maximum shift length could lead to safer patient care.…”

Section: Introductionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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), bibliographies, pertinent reviews, and meeting abstracts. STUDY SELECTION: We included studies examining the relationship between the pre-and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies. DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality. RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Metaanalysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I 2 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies. LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible. CONCLUSIONS:Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.

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Section: Introductionmentioning

confidence: 99%

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

2011

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“…Orthopedic training in Europe and North America has significantly changed in the past decade due to stricter regulations on working time (Philibert et al 2002, Nasca et al 2010). The European Working Time Directive (Department of Health 2004) was initially prepared to safeguard both patients and healthcare professionals by promoting risk reduction and increasing patient safety.…”

mentioning

confidence: 99%

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

et al. 2015

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Background and purpose — Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.Patients and methods — 52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.Results — The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.Interpretation — We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.

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“…Daily cardiac catheterization procedural volume and complications at an academic medical center Recognition of a possible relationship between trainee workload and patient outcomes led the AGME in 2003 to institute restrictions on trainee work hours (9). Some academic centers have reported an association between increased surgical volumes and increased complication rates (10).…”

Section: Original Articlementioning

confidence: 99%

Daily cardiac catheterization procedural volume and complications at an academic medical center

Slicker

Lane

Oyetayo

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Over 1,000,000 cardiac catheterizations (CC) are performed annually in the United States.There is a small risk of complication that has persisted despite advances in technology. It is unknown whether daily CC procedural volume can influence this risk. In an effort to improve outcomes at our academic medical center, we investigated the relationship between daily CC volume and complication rates.Methods: We obtained data from both the National Cardiovascular Data Registry (NCDR) Cath-PCI and Lumedx© databases reviewing the records of patients undergoing scheduled, non-emergent CC at our facility between January 2005 to June 2013. Daily CC volume was analyzed as were complications including death, post-procedure MI, cardiogenic shock, heart failure, stroke, tamponade, bleeding, hematoma and acute kidney injury (AKI).Results: 12,773 patients were identified who underwent 16,612 CCs on 2,118 days. The average age was 63 years (SD 12.4; range,. 61% were men. A total of 326 complications occurred in 243 patients on 233 separate days (2.0% CC complication rate). The average volume per day was 7.8 CCs. We found a low correlation between daily complications and CC volume (Spearman's rho =0.11; P<0.01) though complication rates were lowest on days with 6-11 procedures; higher rates were found on slower and busier days. Conclusions:We observed a U-shaped association between CC volume and rates of CC complications.The lowest complication rates were found on days with 6-11 procedures a day. The highest complication rate was seen with >11 procedures a day.

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New Requirements for Resident Duty Hours

Cited by 466 publications

References 5 publications

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules

Training effect of a virtual reality haptics-enabled dynamic hip screw simulator

Daily cardiac catheterization procedural volume and complications at an academic medical center

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