Inpatient safety outcomes following the 2011 residency work-hour reform.

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Inpatient safety outcomes following the 2011 residency work-hour reform.

J Hosp Med. 2014 Feb 22;

Authors: Block L, Jarlenski M, Wu AW, Feldman L, Conigliaro J, Swann J, Desai SV

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. © 2014 Society of Hospital Medicine.

PMID: 24677678 [PubMed - as supplied by publisher]

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