Limit to Residents' Hours May Not Be Safer?

Little Patient Benefit Seen From Cutting Work Hours for Medical Residents

Medically Reviewed by Louise Chang, MD on September 04, 2007
From the WebMD Archives

Sept. 4, 2007 -- Reforms that cut back on medical residents' long hours havehad little effect on hospital patient deaths, two studies find.

Both studies, from University of Pennsylvania researcher Kevin G. Volpp, MD,PhD, and colleagues, appear in the Sept. 5 issue of The Journal of theAmerican Medical Association.

In 2003, teaching hospitals adopted new rules that cut back on the gruelinghours worked by medical residents -- doctors learning their trade in teachinghospitals. The new rules limit residents to:

  • No more than 80 hours a week
  • No more than 6 work days a week, averaged over 4 weeks
  • No more than 24 continuous hours of duty, except for another 6 hours ofeducation or transfer of care
  • In-house call no more often than every third night
  • No less than 10 hours of rest between duty periods

Sleep specialists worry that these doctors still get too little rest tofunction at their best. On the other hand, hospital experts worry that thereduced hours mean patients are handed off too often, with possiblylife-threatening interruptions of care.

The Volpp studies carry both good and bad news. The good news is thatpatient death rates did not go up in the first two years after the new ruleswent into effect. The bad news is that patient death rates did not go down,except for a small decline in deaths among patients in VA hospitals withgreater teaching intensity.

The findings "reinforce the impression that there is still not clearevidence for an effect of duty hour reforms on [patient] mortality,"suggests an editorial in The Journal of the American MedicalAssociation by David O. Meltzer, MD, PhD, and Vineet M. Arora, MD, ofthe University of Chicago.

Show Sources

SOURCES: Volpp, K.G. The Journal of the American Medical Association, Sept. 5, 2007; vol 298: pp 975-983 and 984-992. Meltzer, D.O. and Arora, V.M. The Journal of the American Medical Association, Sept. 5, 2007; vol 298: pp 1055-1057.

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