Patient Outcomes when Housestaff Exceed 80 Hours per Week

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• 作者：David Ouyang ; MD^a ; Jonathan H. Chen ; MD ; PhD^b ; Gomathi Krishnan ; PhD^c ; Jason Hom ; MD^a ; Ronald Witteles ; MD^a ; Jeffrey Chi ; MD^a ; ^{jeffrey.chi@stanford.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Duty hours ; Electronic health record ; Medical education ; Readmissions
• 刊名：The American Journal of Medicine
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：129
• 期：9
• 页码：993-999.e1
• 全文大小：1331 K

文摘

It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigated whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work more than 80 hours per week.

Methods

We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether the patient was admitted by housestaff who have worked more than 80 hours per week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, intensive care unit (ICU) transfer rate, and 30-day readmission rate.

Results

We identified 4767 hospitalizations by 3450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than 80 hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs 16.7%, P = .031) for patients admitted by housestaff working more than 80 hours per week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs 4.66 days, P = .048) and rate of ICU transfer (3.53% vs 2.38%, P = .029). There was no statistically significant difference in 30-day readmission rate (13.7% vs 12.8%, P = .395) or in-hospital mortality rate (3.18% vs 2.42%, P = .115). There was no correlation with team census on admission and patient outcomes.

Conclusions

Patients taken care of by housestaff working more than 80 hours per week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.