However, shift restrictions may contribute to less time for direct patient care, according to two new studies. Researchers suggest ways to increase that time.

     Limiting residents’ hours has not increased patients’ mortality risk, but it may be leading to less time spent with patients, say two studies in the August issue of the Journal of General Internal Medicine.

     The Accreditation Council for Graduate Medical Education limited resident hours twice in an effort to prevent errors from fatigue — once in 2003, with a cap of 80 hours a week, and again in 2011, when it cut residents’ maximum shift length from 30 hours to 16.

     Critics argued that residents would lose training time and patients would be transferred among more health professionals, increasing the risk of harming patients and breaking continuity of care.

     That’s not what University of Pennsylvania researchers found. They studied 13.7 million Medicare patients admitted to hospitals for acute myocardial infarction, gastrointestinal bleeding, congestive heart failure, and general, orthopedic or vascular surgery between 2000 and 2008. They found no significant difference in mortality within 30 days of admission in the first three years after the 2003 reform and improvement in mortality rates in years four and five (link).

     “We can reassure the public that patients did not appear to be harmed by the initial duty hour reform of 2003,” said senior study author Jeffrey Silber, MD, PhD, professor of health care management at the University of Pennsylvania. He added that although mortality rates did improve in years four and five, researchers could not say definitively that the improvement was due to the reforms and not other factors.

     Dr. Silber said that although the study measures only mortality, “we have published many papers prior to this looking at other outcomes [including prolonged length of stay following 2003 duty hour reform], and we have found similar results.”

     Dr. Silber said the researchers next will look at whether changes in residents’ shift length affected patient outcomes or educational performance.

     Ingrid Philibert, PhD, senior vice president in the department of field activities at the ACGME, said the organization supports further study.

     “These findings offer support for the duty-hour limits,” she said in an email. “The most significant limitation in the results offered are associations, not a clear determination of a cause and an effect. The lag time between the implementation of the standards in 2003 and the effect on patient outcomes suggests that the positive effect of the standards on safety and quality of care may have required changes in care patterns that required some time for hospitals to implement.”

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