Limiting residents' working hours saves lives
BMJ 2007; 334 doi: https://doi.org/10.1136/bmj.334.7607.1296 (Published 21 June 2007) Cite this as: BMJ 2007;334:1296
New regulations limiting the working hours of residents in American teaching hospitals came into force on 1 July 2003⇑. Over the next 18 months, absolute mortality rates in high risk medical inpatients in these hospitals fell by a small but significant 0.25%, relative to similar patients in non-teaching hospitals unaffected by the new rules. Researchers used nationally representative data on more than 1 200 000 adult patients to examine the impact of limiting working hours to 80 or fewer a week and capping continuous shifts at no more than 24 hours.
Medical inpatients older than 80 benefited the most. Their absolute risk of death fell 0.71% between July 2003 and December 2004 (relative change 6.97%, P=0.005). It is not yet clear why. The new rules had no effect on death rates in surgical patients, possibly because surgical residents (or their bosses) failed to follow them. Improvements associated with less tired surgical residents may also have been wiped out by problems with continuity of care and handovers.
Only patients with conditions associated with a high mortality such as heart failure, sepsis, and major joint replacement surgery were analysed. Even so, the researchers were mildly surprised by their positive findings. Previous smaller studies have consistently failed to detect any change in patient outcomes after July 2003.