Limit to Residents‘ Hours May Not Be Safer?

Sept. 4, 2007 -- Reforms that cut back on medical residents' long hours have had little effect on hospital patient deaths, two studies find.

Both studies, from University of Pennsylvania researcher Kevin G. Volpp, MD, PhD, and colleagues, appear in the Sept. 5 issue of The Journal of the American Medical Association.

In 2003, teaching hospitals adopted new rules that cut back on the grueling hours worked by medical residents -- doctors learning their trade in teaching hospitals. The new rules limit residents to:

• No more than 80 hours a week
• No more than 6 work days a week, averaged over 4 weeks
• No more than 24 continuous hours of duty, except for another 6 hours of education or transfer of care
• In-house call no more often than every third night
• No less than 10 hours of rest between duty periods

Sleep specialists worry that these doctors still get too little rest to function at their best. On the other hand, hospital experts worry that the reduced hours mean patients are handed off too often, with possibly life-threatening interruptions of care.

The Volpp studies carry both good and bad news. The good news is that patient death rates did not go up in the first two years after the new rules went into effect. The bad news is that patient death rates did not go down, except for a small decline in deaths among patients in VA hospitals with greater teaching intensity.

The findings "reinforce the impression that there is still not clear evidence for an effect of duty hour reforms on mortality," suggests an editorial in The Journal of the American Medical Association?by David O. Meltzer, MD, PhD, and Vineet M. Arora, MD, of the University of Chicago.