| Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules. | |
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MedLine Citation:
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PMID: 21369772 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Kathlyn E Fletcher; Darcy A Reed; Vineet M Arora |
Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't; Review Date: 2011-03-03 |
Journal Detail:
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Title: Journal of general internal medicine Volume: 26 ISSN: 1525-1497 ISO Abbreviation: J Gen Intern Med Publication Date: 2011 Aug |
Date Detail:
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Created Date: 2011-07-19 Completed Date: 2012-05-25 Revised Date: 2012-09-25 |
Medline Journal Info:
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Nlm Unique ID: 8605834 Medline TA: J Gen Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 907-19 Citation Subset: IM |
Affiliation:
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Department of Medicine, Milwaukee VAMC/ Medical College of Wisconsin, Milwaukee, WI 53295, USA. kfletche@mcw.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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 |
| Comments/Corrections | |
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