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Association of residency work hour reform with long term quality and costs of care of US physicians: observational study

BMJ 2019; 366 doi: https://doi.org/10.1136/bmj.l4134 (Published 10 July 2019) Cite this as: BMJ 2019;366:l4134

Re: Association of residency work hour reform with long term quality and costs of care of US physicians: observational study

In a somewhat different context, also using the Nationwide Inpatient Sample, we examined the outcomes of neurosurgical patients treated in hospitals with neurosurgery resident training programs before and after the 2003 duty hours regulations were implemented. We chose neurosurgery residents because they are among those with the greatest reduction in duty hours imposed by the 2003 changes. We arrived at the same conclusion: there was no effect on mortality or the percentage of patients discharged directly home. (1)

These results can be interpreted as the authors of the present study have: that reduction in duty hours does not affect long term quality of care. However, they can also be interpreted as demonstrating that the reduction in duty hours has not increased the quality or safety of patient care.

As one major rationale for the changes was exactly that - to improve patient safety, these duty hour reductions, which have been estimated to have cost $1.6 billion (2), can be said to have been an expensive failed experiment in improving patient safety.

Reduced duty hours have many benefits for the trainee. I support them when implemented flexibly. But the rationale for such changes must be focused on benefits to the trainee as no major benefit in the quality or safety of patient care has been demonstrated.

1. Norby K, Siddiq F, Adil MM, Haines SJ. The effect of duty hour regulations on outcomes of neurological surgery in training hospitals in the United States: duty hour regulations and patient outcomes. J Neurosurgery 2014;121:247-261
2. Tan P, Hogle NJ, Widmann WD: Limiting PGY 1 residents to 16 hours of duty: review and report of a workshop. J Surg Educ 2012; 69:355–359

Competing interests: No competing interests

12 July 2019
Stephen J Haines
Professor of Neurosurgery
University of Minnesota
MMC96, Suite D429, 420 Delaware St. SE, Minneapolis, MN 55455