Association of Resident Duty Hour Restrictions on Mortality of Nervous System Disease and Disorder

Abstract

Background: The impact of the 2003 residency duty hour reform on patient care remains a debated issue.

Objective: Determine the association between duty hour limits and mortality in patients with nervous system pathology.

Methods: Via a retrospective cohort study using the Nationwide Inpatient Sample from 2000-2010, the authors evaluated in-hospital mortality status in those with a primary discharge level diagnosis of disease or disorder of the nervous system. Odds ratios were calculated, and Bonferroni corrected P values and confidence intervals were determined to account for multiple comparisons relating in-hospital mortality with teaching status of the hospital by year.

Results: The pre-reform (2000-2002) and peri-reform (2003) periods revealed no significant difference between teaching and nonteaching hospital mortality (P > .99). The post-reform period (2004-2010) was dominated by years of significantly higher mortality rates in teaching hospitals compared to nonteaching hospitals: 2004 (P < .001); 2006 (P = .043); 2007 (P = .042); and 2010 (P = .003). However, data for 2005 (P ≥ .99), 2008 (P = .80), and 2009 (P = .09) did not show a significant difference in mortality.

Conclusions: Teaching and nonteaching hospital mortality was similar in patients with nervous system pathology prior to the duty hour reform. While nonteaching institutions demonstrated steadily declining mortality over the decade, teaching hospital mortality spiked in 2004 and declined at a more restricted rate. The timing of these changes could suggest a negative correlation of duty hour restrictions on outcomes of patients with nervous system pathology.

Figure

Nervous System Disease/Disorder Mortality by Hospital Teaching Status Abbreviations: MDC, major diagnosis category; HCUP, Healthcare Cost and Utilization Project; NIS, Nationwide Inpatient Sample. Note: Mortality rates by hospital teaching status for patients with MDC01 were queried from HCUP-Net NIS data from 2000–2010. Values were plotted for each year of the study period. Teaching hospitals = light gray dashed line; nonteaching hospitals = dark gray solid line; duty hour restriction implementation = vertical dashed line.