JAMA Studies Find Limits on Residents' Hours Don't Improve Patient Safety

Restricting work hours for medical residents has not improved patient care, as suggested by findings in two studies recently published in the Journal of the American Medical Association (JAMA).

A study by the University of Pennsylvania examined whether rules limiting resident hours put in place by the 2011 Accreditation Council for Graduate Medical Education (ACGME) affected patient mortality rates and hospital readmissions. The second study, from the American College of Surgeons and Northwestern University, looked at how those restrictions affected surgery outcomes. Both studies found no significant change in correlation to the work restrictions.

In 2011, ACGME reduced residents’ consecutive work hours from 30 a week to no more than 16 consecutive hours for interns and 24 hours for other residents, according to the University of Pennsylvania study. This expanded on reforms initiated in 2003, which limited residents’ work hours to 80 total per week. The restrictions were meant to improve patient care as tired residents were thought to be more prone to make mistakes.

The University of Pennsylvania study examined Medicare beneficiaries. It concluded that among those beneficiaries “there were no significant differences in the change in 30-day mortality rates or 30-day all-cause readmission rates for those hospitalized” in the year after implementation when compared with those hospitalized two years before the reforms.

No Notable Improvement in Patient Safety

“The work-hour restrictions have been controversial because there have been questions whether they are positive or negative,” Dr. James Arrighi, an associate professor of medicine at Brown University in Providence, R.I., said in a HealthDay article.

“Overall, the duty hour restrictions in themselves haven’t resulted in a notable improvement in patient safety or quality of care or patient outcome,” Dr. Arrighi said in the article.

The second study looked at the outcomes of more than 200,000 general surgery patients for the two years following the reforms. It concluded that “implementation of the 2011 ACGME duty hour reform was not associated with a change in general surgery patient outcomes or differences in resident examination performance.”

This study also found that resident test scores remain virtually unchanged since the ACGME hour restrictions were put in place.

Dr. Karl Bilimoria, an assistant professor of surgery at Northwestern University Feinberg School of Medicine in Chicago, said in the HealthDay article that although patient outcomes or scoring on tests did not worsen, they also didn’t improve.

“We think that these restrictions are limiting continuity of care and hurting care,” Dr. Bilimoria said in the article. “In absence of an improvement in outcomes, we would suggest that these rules are not necessary. They should be repealed.”

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