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Patient Safety and Quality

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Resident work hour limits in New York teaching hospitals were not associated with improved safety for surgery patients

Since July 2003, the work hours of physician residents in training have been limited to 80 hours per week in the hopes of limiting physician fatigue that has been linked to medical error. However, a recent study found that resident work hour limits were not associated with improved safety among surgery patients at a teaching hospital in New York, the first State to enforce such limits in 1998. The study, which was supported by the Agency for Healthcare Research and Quality (T32 HS13833), found worsening trends for two of the five types of surgical patient safety indicators (PSIs) evaluated.

The researchers analyzed Nationwide Inpatient Sample data on New York hospitals from 1995 to 2001 on an average of 2.6 million mean New York discharges per year. They examined the impact of work hour limits on five surgical PSIs developed by AHRQ: accidental puncture or laceration (APL), postoperative pulmonary embolus or deep venous thrombosis (PEDVT), foreign body left during procedure (FB), iatrogenic (care-caused) pneumothorax (PTX), and postoperative wound dehiscence (reopening, WD). They compared rates of the PSIs before and after implementation of work hour limits in New York teaching hospitals and in two control groups, New York nonteaching hospitals and California teaching hospitals.

The researchers found increased rates over time (expressed per 1,000 discharges each quarter) for both APL and PEDVT after enforcement of work hour limits in New York teaching hospitals. No changes were observed in either control group for these PSIs or in New York teaching hospital rates of FB, PTX, or WD. Because of study design limitations, the reasons for increased rates of APL and PEDVT remain elusive. The researchers suggest that fewer hours for surgical trainees to become technically proficient could have led to more technical errors during procedures (APL). Also, more shifts and hence more information exchanges necessitated by shorter work schedules might have led to higher rates of postoperative PEDVT if appropriate and timely anticoagulant measures were not communicated and instituted.

See "Resident work hour limits and patient safety," by Benjamin K. Poulose, M.D., Wayne A. Ray, Ph.D., Patrick G. Arbogast, Ph.D., and others, in the June 2005 Annals of Surgery 241(6), pp. 847-860.

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