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J Gen Intern Med. 2011 Aug;26(8):907-19. doi: 10.1007/s11606-011-1657-1. Epub 2011 Mar 3.

Patient safety, resident education and resident well-being following implementation of the 2003 ACGME duty hour rules.

Author information

  • 1Department of Medicine, Milwaukee VAMC/ Medical College of Wisconsin, Milwaukee, WI 53295, USA. kfletche@mcw.edu

Abstract

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.

PMID:
21369772
[PubMed - indexed for MEDLINE]
PMCID:
PMC3138977
Free PMC Article

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