Shorter Hours = Better Patient Care

Horwitz, et. al. “Changes in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations.” Annals of Internal Medicine, July 17, 2007;147:(2). (Download in PDF)
   
The work hour limits adopted by the ACGME in 2003 have led to better patient care, according to a new study published in the July 17th issue of the Annals of Internal Medicine. The study, conducted by researchers at Yale-New Haven Hospital, found that the care provided by intern and resident physicians after the implementation of work hour limits displayed significant improvements in key areas of patient outcome compared with the care provided before the limits were adopted.

The study examined data collected on all patients discharged from the medical wards at Yale-New Haven Hospital during both the year preceding and the year following the implementation of the ACGME work hours regulations on July 1, 2003. To gauge outcome, the researchers looked at variables like ICU stay, length of hospital stay, discharge disposition, medication errors, and 30-day readmission rate.  As a control, the researchers also examined the same outcomes for patients under the care of the hospital’s non-teaching service, which was not affected by the work hours rule change.

Addressing concerns about the potential for error in the increased patient hand-offs necessitated by work hours limitation, the researchers wrote, “we found that a major reorganization of patient care to reduce resident work hours was implemented without evidence of harm to patients, despite concern about possible adverse effects of discontinuity.” “Overall,” the researchers concluded, “the [work hours] regulations were associated with neutral or positive changes in all of the outcomes we studied.”