First, do no harm: Limiting resident work hours does not harm ICU patients

Limits on the number of hours that medical residents are allowed to work in a day does not negatively affect outcomes in even the most sensitive patient population: critically ill patients in intensive care units. Moreover, there has been a decrease in mortality among ICU patients in both teaching and non-teaching hospitals alike during the work-hours reform. The research will be presented at the American Thoracic Society’s 2008 International Conference in Toronto on Wednesday, May 21. The reform limited the total number of weekly working hours, the number of consecutive working hours and the number of working days without a break. When these limits were implemented across the U.S. in 2003, there was concern among clinicians and educators that, despite the projected reduction in fatigue-related medical errors, critically ill patients may suffer from the decrease in continuity of care because of shorter shift times.

“This is the first study to quantifiably determine that there is no net negative outcome in critically ill patients associated with shorter work hours, and in fact, over time, there may even be a benefit to patients,” said Meeta Prasad, M.D., postgraduate fellow in pulmonary and critical care medicine at the University of Pennsylvania.

The researchers analyzed in-hospital mortality across 40 institutions, including more than 230,000 patients, from July 1, 2001 to June 30, 2005. About one-third of the patients were treated in 16 non-teaching hospitals, with the remainder in 24 teaching hospitals. The researchers compared in-hospital mortality between patients admitted after June 1, 2003, when working hour limits began to be enforced, and those admitted before the change.

“We found a small but significant decrease in patient mortality after the changes in the work-hours regulations,” said Dr. Prasad. “This suggests that medical training may not require such brutal hours and sleep deprivation, and that the means to compensate for fewer work hours of residents has not compromised patient care. Our findings are interesting because they begin to answer the important controversy in medical education and patient safety.”

This also has important implications for hospital education and policy. “This provides some reassurance and support for the continued improvement of the medical training environment,” concluded Dr. Prasad.

Source: American Thoracic Society