Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2005 Jun;241(6):847-56; discussion 856-60.
doi: 10.1097/01.sla.0000164075.18748.38.

Resident work hour limits and patient safety

Benjamin K Poulose  1 , Wayne A Ray, Patrick G Arbogast, Jack Needleman, Peter I Buerhaus, Marie R Griffin, Naji N Abumrad, R Daniel Beauchamp, Michael D Holzman
Affiliations

Resident work hour limits and patient safety

Benjamin K Poulose et al. Ann Surg. 2005 Jun.

Abstract

Objective: This study evaluates the effect of resident physician work hour limits on surgical patient safety.

Background: Resident work hour limits have been enforced in New York State since 1998 and nationwide from 2003. A primary assumption of these limits is that these changes will improve patient safety. We examined effects of this policy in New York on standardized surgical Patient Safety Indicators (PSIs).

Methods: An interrupted time series analysis was performed using 1995 to 2001 Nationwide Inpatient Sample data. The intervention studied was resident work hour limit enforcement in New York teaching hospitals. PSIs included rates of accidental puncture or laceration (APL), postoperative pulmonary embolus or deep venous thrombosis (PEDVT), foreign body left during procedure (FB), iatrogenic pneumothorax (PTX), and postoperative wound dehiscence (WD). PSI trends were compared pre- versus postintervention in New York teaching hospitals and in 2 control groups: New York nonteaching hospitals and California teaching hospitals.

Results: A mean of 2.6 million New York discharges per year were analyzed with cumulative events of 33,756 (APL), 36,970 (PEDVT), 1,447 (FB), 10,727 (PTX), and 2,520 (WD). Increased rates over time (expressed per 1000 discharges each quarter) were observed in both APL (0.15, 95% confidence interval, 0.09-0.20, P<0.05) and PEDVT (0.43, 95% confidence interval, 0.03-0.83, P<0.05) after policy enforcement in New York teaching hospitals. No changes were observed in either control group for these events or New York teaching hospital rates of FB, PTX, or WD.

Conclusions: Resident work hour limits in New York teaching hospitals were not associated with improvements in surgical patient safety measures, with worsening trends observed in APL and PEDVT corresponding with enforcement.

PubMed Disclaimer

Figures

None
FIGURE 1. Accidental puncture or laceration rates for New York (NY) teaching hospitals, NY nonteaching hospitals (concurrent control group), and California (CA) teaching hospitals (concurrent control group) plotted over time (year and first quarter “q1” are indicated). Dashed vertical line indicates intervention time of resident work hour limit enforcement (second quarter of 1998) in NY teaching hospitals. The top graph in each figure plots risk-adjusted rates, and the bottom graph shows time series smoothed risk-adjusted rates for clarity. Changes in PSI rate per 1000 discharges per quarter (risk-adjusted) are shown for each study group in the preintervention and postintervention periods with 95% confidence intervals and asterisk (*) indicating P < 0.05 by regression modeling.
None
FIGURE 2. Postoperative pulmonary embolus (PE) or deep venous thrombosis (DVT) rates for New York (NY) teaching hospitals, NY nonteaching hospitals (concurrent control group), and California (CA) teaching hospitals (concurrent control group) plotted over time. Graphing convention and data presentation are described in Figure 1; asterisk (*) indicates P < 0.05 by regression modeling.
None
FIGURE 3. Foreign body left during procedure rates for New York (NY) teaching hospitals, NY nonteaching hospitals (concurrent control group), and California (CA) teaching hospitals (concurrent control group) plotted over time. Graphing convention and data presentation are described in Figure 1; asterisk (*) indicates P < 0.05 by regression modeling.
None
FIGURE 4. Iatrogenic pneumothorax rates for New York (NY) teaching hospitals, NY nonteaching hospitals (concurrent control group), and California (CA) teaching hospitals (concurrent control group) plotted over time. Graphing convention and data presentation are described in Figure 1; asterisk (*) indicates P < 0.05 by regression modeling.
None
FIGURE 5. Postoperative wound dehiscence rates for New York (NY) teaching hospitals, NY nonteaching hospitals (concurrent control group), and California (CA) teaching hospitals (concurrent control group) plotted over time. Graphing convention and data presentation are described in Figure 1; asterisk (*) indicates P < 0.05 by regression modeling.
See this image and copyright information in PMC

References

    1. Bell BM. The new hospital code and the supervision of residents. N Y State J Med. 1988;88:617–619. - PubMed
    1. Brensilver JM, Smith L, Lyttle CS. Impact of the Libby Zion case on graduate medical education in internal medicine. Mt Sinai J Med. 1998;65:296–300. - PubMed
    1. Samkoff JS, Jacques CH. A review of studies concerning effects of sleep deprivation and fatigue on residents’ performance. Acad Med. 1991;66:687–693. - PubMed
    1. Kohn LT, Corrigan JM, Donaldson MS. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000. - PubMed
    1. Whang EE, Mello MM, Ashley SW, et al. Implementing resident work hour limitations: lessons from the New York State experience. Ann Surg. 2003;237:449–455. - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources