Well-Rested Docs Mean Better Care For Patients

Shortening resident physicians' hours improves hospital care, study finds

FRIDAY, May 12, 2006 (HealthDay News) -- Hospital resident doctors who worked fewer hours provided better care for their heart patients, a new study finds.

The findings appear to support new restrictions on U.S. medical residents' work hours implemented since 2003.

Doctors and their patients may each benefit from the new rules, experts say.

"New residency hours restrictions that we're facing don't necessarily have to lead to either poorer efficiency or poorer quality in coronary care if they occur in a setting where there's a system that provides for that quality," said senior study author Dr. Kim Eagle, the Albion Walter Hewlett Professor of Internal Medicine at the University of Michigan in Ann Arbor.

His team members "are providing evidence that patient care is not negatively affected by the institution of the duty hours," said Ingrid Philibert, director of field activities at the Accreditation Council for Graduate Medical Education (ACGME), which instituted the U.S.-wide guidelines.

The findings were presented this week at the American Heart Association's 7th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Washington D.C.

Starting July 1, 2003, the ACGME, which evaluates and accredits U.S. medical school residence programs, limited the maximum working hours for residents to 80 per week.

The action was taken in response to concern that lengthy hours left residents tired and prone to making dangerous medical errors.

Others, however, worried that the changes would interrupt continuity of care.

"Clearly the concept of having a sleep-deprived house officer in the middle of the night making decisions for acutely ill patients is something all of us can respond to emotionally," Eagle said. "At the same time, people my age trained when that was expected and had the feeling that by being with the patient right through, we would do a better job."

"Many thought that if the house officer was admitting overnight, then had to go home, that continuity of care could be lost and that there might be poorer efficiency," he continued.

To try to settle the issue, Eagle and his colleagues analyzed 1,000 patients with Acute Coronary Syndrome (ACS) admitted to the University of Michigan hospital between July 2002 and June 2004.

The researchers compared the outcomes of patients admitted to the hospital before the new duty-hour changes took effect to outcomes of patients admitted after the changes.

After the new rules went into effect, the researchers observed no differences in mortality rates. However, they did find improvements in levels of care, specifically in adherence to evidence-based guidelines.

During 2003-2004, 71.8 percent of patients were prescribed an ACE inhibitor or angiotensin receptor blocker, as recommended by the expert guidelines, vs. 65.7 percent of patients admitted during 2002-2003.

In addition, 84 percent of patients admitted during the later period were prescribed a cholesterol-lowering statin drug, vs. 69.8 percent in the earlier period. Almost 94 percent of the 2003-04 patients were prescribed a beta-blocker medication, compared with 85.8 percent in the earlier group.

Length of hospital stay decreased by slightly more than one day (five days versus 3.9 days) between the earlier and later periods.

There were no significant differences in congestive heart failure, pulmonary edema (swelling), cardiac shock and strokes.

The authors acknowledged that some of the improvements may have been due to a quality improvement initiative implemented at the facility during the study period.

Others agreed. "It's clear that they tried to improve evidence-based medicine, so it's not possible to clearly tell whether that program or good duty hour guidelines or, more likely, both collectively, were responsible," Philibert said.

The new hours most likely did play a major role, however.

"Residents could be up all night admitting five or six patients and then the next morning they're struggling to get them all scheduled for testing or treatment," Eagle said. "With the new restrictions, you have a fresh house officer coming in the morning who works directly with admitting residents; you get a fresh pair of legs to hunt down lab tests and schedules. It speeds efficiency having a fresh person."

More information

For more on duty hours, visit the ACGME.

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