Document Detail


Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules.
MedLine Citation:
PMID:  21369772     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: The ACGME-released revisions to the 2003 duty hour standards.
OBJECTIVE: To review the impact of the 2003 duty hour reform as it pertains to resident and patient outcomes.
DATA SOURCES: Medline (1989-May 2010), Embase (1989-June 2010), 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. Meta-analysis 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.
Authors:
Kathlyn E Fletcher; Darcy A Reed; Vineet M Arora
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review     Date:  2011-03-03
Journal Detail:
Title:  Journal of general internal medicine     Volume:  26     ISSN:  1525-1497     ISO Abbreviation:  J Gen Intern Med     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-07-19     Completed Date:  2012-05-25     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8605834     Medline TA:  J Gen Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  907-19     Citation Subset:  IM    
Affiliation:
Department of Medicine, Milwaukee VAMC/ Medical College of Wisconsin, Milwaukee, WI 53295, USA. kfletche@mcw.edu
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MeSH Terms
Descriptor/Qualifier:
Attitude of Health Personnel*
Humans
Internship and Residency / legislation & jurisprudence*,  trends
Patient Safety / legislation & jurisprudence*
Personal Satisfaction*
Personnel Staffing and Scheduling / legislation & jurisprudence*,  trends
Retrospective Studies
Work Schedule Tolerance / psychology*
Workload / legislation & jurisprudence,  psychology
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