Inpatient safety outcomes following the 2011 residency work-hour reform

Publication Date

2014

Journal Title

J Hosp Med

Abstract

BACKGROUND The impact of the 2011 residency work-hour reforms on patient safety is not known. OBJECTIVE To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center. DESIGN Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes. PATIENTS All adult patients discharged from general medicine services from July 2008 through June 2012. MEASUREMENTS Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index. RESULTS Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes. CONCLUSIONS In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety. Journal of Hospital Medicine 2014;9:347-352. (c) 2014 Society of Hospital Medicine

Volume Number

9

Issue Number

6

Pages

347-352

Document Type

Article

EPub Date

2014/03/29

Status

Faculty

Facility

School of Medicine

Primary Department

Science Education

Additional Departments

General Internal Medicine

PMID

24677678

DOI

10.1002/jhm.2171

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