Longer surgical resident hours don't hinder patient care, study says

Extending hours for surgical residents doesn't negatively affect patient care, according to a New England Journal of Medicine study. In fact, longer hours may improve patient recovery if surgical residents stay with patients post-operation or are on hand to help stabilize them in critical situations, according to the authors.

Researchers analyzed data from 117 residency programs across 151 hospitals and health systems and found those using more flexible duty hours for residents yielded no significant difference in residents' self-reported satisfaction, overall well-being, quality of training or patient outcomes for 10 metrics.

The conclusions of the new study, which were presented at the Academic Surgical Congress on Tuesday, are a bit counterintuitive. Longer clinical hours are often associated with fatigue, burnout or slip-ups, and the issue has attracted regulatory attention. The Accreditation Council for Graduate Medical Education revised its policies around shift hours for residents twice, first in 2003 and again in 2011. The 2003 revision mandated that residents work under 80 hours per week, including restrictions for minimum amount of time between shifts and caps on overnight shift length. The 2011 update decreased the acceptable shift length for residents and increased the amount of time they are required to take off between shifts.

However, the authors suggest the real cause of errors in patient care occur during hand-offs, when a physician or medical staffer updates the incoming clinicians about the status of a patient. 

"In surgery, this more frequent turnover may compromise continuity of patient care, potentially jeopardize patient safety and decrease the quality of resident education by forcing residents to leave at critical times, such as in the middle of an operation or while stabilizing a critically ill patient," Karl Bilimoria, MD, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago and co-author of the study, said in a statement.

Greater flexibility in surgical resident works hours can prevent patient care disruptions without impacting outcomes or surgical education, the authors concluded.

More articles on quality:

Dr. Peter Pronovost: 9 necessary patient safety growth areas
Labor and delivery bundle may improve patient outcomes: 3 study findings
One reason for increased hospital safety costs? Patients aren't getting evidence-based care

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