Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules. J Gen Intern Med 2011 Aug;26(8):907-19
Date
03/04/2011Pubmed ID
21369772Pubmed Central ID
PMC3138977DOI
10.1007/s11606-011-1657-1Scopus ID
2-s2.0-80051544743 (requires institutional sign-in at Scopus site) 78 CitationsAbstract
CONTEXT: The ACGME-released revisions to the 2003 duty hour standards.
OBJECTIVE: To review the impact of the 2003 duty hour reform as it pertains to resident and patient outcomes.
DATA SOURCES: Medline (1989-May 2010), Embase (1989-June 2010), bibliographies, pertinent reviews, and meeting abstracts.
STUDY SELECTION: We included studies examining the relationship between the pre- and post-2003 time periods and patient outcomes (mortality, complications, errors), resident education (standardized test scores, clinical experience), and well-being (as measured by the Maslach Burnout Inventory). We excluded non-US studies.
DATA EXTRACTION: One rater used structured data collection forms to abstract data on study design, quality, and outcomes. We synthesized the literature qualitatively and included a meta-analysis of patient mortality.
RESULTS: Of 5,345 studies identified, 60 met eligibility criteria. Twenty-eight studies included an objective outcome related to patients; 10 assessed standardized resident examination scores; 26 assessed resident operative experience. Eight assessed resident burnout. Meta-analysis of the mortality studies revealed a significant improvement in mortality in the post-2003 time period with a pooled odds ratio (OR) of 0.9 (95% CI: 0.84, 0.95). These results were significant for medical (OR 0.91; 95% CI: 0.85, 0.98) and surgical patients (OR 0.86; 95% CI: 0.75, 0.97). However, significant heterogeneity was present (I(2) 83%). Patient complications were more nuanced. Some increased in frequency; others decreased. Outcomes for resident operative experience and standardized knowledge tests varied substantially across studies. Resident well-being improved in most studies.
LIMITATIONS: Most studies were observational. Not all studies of mortality provided enough information to be included in the meta-analysis. We used unadjusted odds ratios in the meta-analysis; statistical heterogeneity was substantial. Publication bias is possible.
CONCLUSIONS: Since 2003, patient mortality appears to have improved, although this could be due to secular trends. Resident well-being appears improved. Change in resident educational experience is less clear.
Author List
Fletcher KE, Reed DA, Arora VMAuthor
Kathlyn E. Fletcher MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Attitude of Health PersonnelHumans
Internship and Residency
Patient Safety
Personal Satisfaction
Personnel Staffing and Scheduling
Retrospective Studies
Work Schedule Tolerance
Workload