Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules - AHRQ Patient Safety Network

Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules.

Fletcher KE, Reed DA, Arora VM. J Gen Intern Med. 2011 Mar 3; [Epub ahead of print].

This systematic review of the effect of physician duty hour regulations found that the regulations were associated with improved resident well-being, but had mixed effects on resident educational outcomes and clinical outcomes.

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AHRQ Patient Safety Network

J Gen Intern Med. 2011 Mar 3. [Epub ahead of print]

Patient Safety, Resident Education and Resident Well-Being Following Implementation of the 2003 ACGME Duty Hour Rules.
Fletcher KE, Reed DA, Arora VM.

Department of Medicine, Milwaukee VAMC/ Medical College of Wisconsin, Clement J. Zablocki VAMC, 5000 W. National Ave, Milwaukee, WI, 53295, USA, kfletche@mcw.edu.

Abstract
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.

PMID: 21369772 [PubMed - as supplied by publisher]
Patient Safety, Resident Education and Resident We... [J Gen Intern Med. 2011] - PubMed result