Association for Surgical Education
The effect of a rotating night-float coverage scheme on preventable and potentially preventable morbidity at a level 1 trauma center

https://doi.org/10.1016/j.amjsurg.2005.03.026Get rights and content

Abstract

Background

The effect of resident work-hour restriction on patient outcome remains controversial.

Methods

Demographic data, mechanism of injury, length of hospital stay length of intensive care unit (ICU) stay, ventilator days, mortality, and complication data were prospectively collected for 11 months before and 11 months after institution of a rotating night-float system. Seven attending surgeons reviewed all complications and categorized each as preventable, potentially preventable, or nonpreventable.

Results

Both study periods were comparable with respect to demographic data, mean Injury Severity Score, mechanism of injury, and admissions. Limitation of resident work hours had no effect on length of hospital or ICU stay, ventilator days, or mortality. Work-hour restrictions did not increase or decrease the total number of complications nor did it alter the distribution of those determined to be preventable or potentially preventable.

Conclusions

Resident work-hour restrictions were not associated with significant improvement or deterioration in patient outcome.

Section snippets

Data collection

The Institutional Review Board of East Carolina University, Brody School of Medicine approved the design and conduct of this study. All 2826 patients admitted to East Carolina University’s level 1 trauma service between November 2001 and August 2003 were eligible for inclusion and were reviewed. Demographic, Injury Severity Score (ISS), length of hospital stay, length of intensive care unit (ICU) stay, ventilator days, mortality, and complication data were prospectively collected for 11 months

Results

After institution of this coverage scheme, resident work hours were successfully decreased from an estimated 100 to 105 hours per week to a mean of 78.4 hours per week. There was no significant difference in demographic profiles between the 2 study periods. The number of admissions, mean ISS, length of hospital stay, length of ICU stay, ventilator days, and overall mortality were also similar before and after institution of our rotating night-float system. These data are presented in Table 1.

Comments

The recent policy change by the Accreditation Council for Graduate Medical Education restricting resident work hours was in large part because of public concern regarding patient safety. Medical errors and their potential association with prolonged resident work hours are frequently reported in the lay press. Therefore, it is intuitive for the general public to assume that limiting resident work hours is an easy way to decrease the medical errors associated with patient injury and death [16].

Conclusion

Although additional study is warranted to fully delineate the effect of resident work-hour restriction on attending workload, resident scholarship, technical performance, and preparedness for practice, these areas were not addressed in our investigation. In our system, resident work-hour restrictions did not improve or worsen the occurrence of overall complications or change the distribution of those determined to be preventable or potentially preventable. These findings support the belief that

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