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More Evidence Needed to Assess Impact of Duty Hour Policies

Rigidity of surgical resident policies may have unintended, detrimental effects on patient

FRIDAY, April 24, 2015 (HealthDay News) -- Evidence is necessary to assess the safety of duty hour limit policies for surgical residents, according to a viewpoint piece published online April 22 in JAMA Surgery.

Karl Y. Bilimoria, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues discuss the evidence base for duty hour requirements for all residencies, implemented in 2003.

The authors note that evidence supporting the effect of duty hour reform was mainly generated after implementation of these polices. Some benefits were reported with duty hour reform, but their rigidity may have unintended, detrimental effects on patients. Prospective studies are needed to generate high-level evidence to inform policy. In order to assess the safety of greater flexibility in duty hour policy, the authors are conducting a prospective, cluster-randomized trial at 152 hospitals in the United States. Hospitals have been randomized to current national duty hour requirements versus flexible duty hour requirements. The authors will compare patient outcomes using the American College of Surgeons National Surgical Quality Improvement Program.

"Policies limiting resident duty hours were well intended but lacked a strong evidence base and pose threats to quality of care and resident education," the authors write. "If trials of increased flexibility in duty hour requirements show no change in clinical outcomes for patients or in resident well-being, policies should be changed to allow more flexible work hours for residents as this will likely improve patient safety and resident education."

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