Resident duty-hour restrictions have negative impacts on patient outcomes and performance on certification examinations, according to an analysis of duty-hour studies, which was published in the March issue of Annals of Surgery.
Researchers conducted a systematic review of resident duty-hour studies, analyzing 16-hour shifts and night float systems separately, and found there was no overall improvement in patient outcomes as a result of resident duty hours. Some studies did suggest increased complication rates in high-acuity patients.
The analysis also found there was no improvement in education related to duty-hour restrictions, and performance on certification exams declined in some specialties.
The Accreditation Council for Graduate Medical Education (ACGME) instituted duty-hour limits in 2003, intending to reduce medical errors, improve patient care and enhance resident wellness. The core of the restrictions include 80-hour work weeks (averaged over four weeks), one day off for every seven days worked (averaged over four weeks) and being on call no more frequently than every third night.
The ACGME last month announced its support for two large national, multi-institutional resident trials to address questions about the effects of duty-hour standards. The ACGME will waive certain duty-hour standards for the two trials at participating hospitals, but certain core standards, including the 80-hour work week, will remain in place.
The review in Annals of Surgery found there were improvements in resident wellness after the 80-hour work week, but there was little improvement or negative effects on wellness after 16-hour duty maximums were implemented.
“Greater flexibility to accommodate resident training needs is required,” the analysis said. “Further erosion of training time should be considered with great caution.”
