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

Abstract

), 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.

Assessing the Utility of ICU Readmissions as a Quality Metric

“…Our fi ndings are consistent with studies showing that in-hospital outcomes for patients in the ICU improved over this time period independent of work-hour reforms. [43][44][45][46][47][48][49][50][51][52][53][54] Taken together, these results support the view that an ICU's readmission rate refl ects operational policies or practice variation not in the causal pathway to mortality. Th is conclusion is supported by complementary data indicating that the readmission rate of an ICU is uncorrelated with performance on other measures of ICU quality.…”

A Narrative Review of Surgical Resident Duty Hour Limits: Where Do We Go From Here?

“…The effect of resident duty hour limits on the quality of education is difficult to track because studies are limited by imprecise and largely nonvalidated outcome measures. 4,20,21,25 Current assessments include operative volume, intraining examination scores, national board examination passing rates, and survey studies of residency program directors and residents. 4,20,21,25 Many studies have concluded that there has been no change in resident education since the implementation of the duty hour limits.…”

“…22,23 However, larger systematic reviews have concluded that these studies suffer from a number of limitations, including small sample sizes, lack of robust methods for measuring patient safety outcomes, lack of control groups, and the potential for both cultural and publication bias. 4,20,21,24,25 In addition, many systematic reviews did not focus specifically on surgical disciplines, which may limit their applicability to surgical trainees.…”

Problem niedoboru lekarzy — czy jest na to remedium?

“…Dyżur medyczny to czas poświęcony na pracę, za którą należy się wynagrodzenie. Wymiar czasu pracy lekarzy zależy od ich woli, w świetle czego mogą go legalnie ograniczyć do ustawowego minimum [15][16][17][18][19][20][21][22].…”