New trainee docs' work hours hasn't hurt patients
NEW YORK (Reuters Health) -The notoriously long hours worked in hospitals by newly graduated doctors, known as residents, were recently cut back in the U.S., and the move seems to have improved death rates for certain medical conditions at Veterans Affairs hospitals.
In other settings, neither beneficial nor harmful effects on survival were seen, according to the results of two related studies appearing in this week's Journal of the American Medical Association.
"This is the largest and most definitive study conducted of the impact of regulating work hours for physicians in training on mortality rates," Dr. Kevin G. Volpp, a researcher at the Philadelphia VA Medical Center and lead author of both studies, told Reuters Health. The results suggest that "on balance, regulation of work hours for physicians in training has not harmed patient outcomes; there may have been benefits in some settings such as the VA."
The work hour limits put into place on July 1, 2003, dictate, among other things, that residents work no more than 80 hours per week and have at least 1 day in 7 free of all duties.
The two studies were identical except that one focused on hospitalized Medicare beneficiaries and the other looked at patients admitted to VA hospitals. In both, mortality rates were examined from July 2000 to June 2005, which enabled the researchers to make comparisons before and after the new work hour limits were in place.
The studies included patients with heart attack, heart failure, gastrointestinal bleeding, or stroke, as well as those admitted for general, orthopedic or vascular surgery.
In the Medicare study, which involved more than 8 million patients, the new work hour limits had no significant effect on mortality rates.
By contrast, in the VA study, which featured over 300,000 patients, the limits were associated with a 26 percent reduction in mortality for the four medical conditions studied. The most pronounced reduction -- 52 percent -- was for heart attack. The limits had no apparent effect on mortality for surgical patients.
Taken together, these findings suggest "that the benefits of reducing fatigue from reducing work hours were at least equal to the potential downsides from worsened continuity of care," Volpp explained.
Given the evidence "suggesting higher rates of car accidents among residents who work longer hours," he concluded, "this suggests that regulation of work hours has probably made residents better off and at the least not made patients worse off."
SOURCE: Journal of the American Medical Association, September 5, 2007.
