Resident work-hour restrictions yield little improvement in perceived quality of patient care
Boston (Oct. 2006) -- Research conducted by participants at several medical schools, including co-authors Michael J. Cunningham, M.D., and Roland D. Eavey, M.D., of the Massachusetts Eye and Ear Infirmary Pediatric Otolaryngology Service, Department of Otology and Laryngology, Harvard Medical School, has found that reducing the amount of work hours alone for surgical residents does not appear to improve quality of patient care. The study is published in the October issue of the Journal of Surgical Research.
Research was conducted on a convenience sample of 156 residents from three surgical specialties who completed questionnaires designed to measure subjective impressions about the quality of patient care. The sample consisted of residents who were already regulated by work-hour restriction (maximum 80-hour work week) and residents who had not previously been regulated by work-hour restriction. With a 94.5 percent response rate, more than 88 percent of residents reported that the quality of patient care remained unchanged (63 percent) or was worse (26 percent) after work-hour restrictions had been implemented. This response was particularly true from those residents who had not previously been regulated by work-hour restrictions. Overall, residents reported fewer fatigue-related errors following implementation of work-hour restrictions. However, more errors were perceived to be related to continuity of care, miscommunication and cross-coverage availability.
"The bad news is that a single change to relieve long work schedules of surgical house officers in order to improve quality apparently has 'failed,'" says senior author, Dr. Eavey, Director of Pediatric Otolaryngology at the Massachusetts Eye and Ear Infirmary. "Those same, well-rested house officers perceive that patient care quality unfortunately did not improve. The good news is that the survey has revealed realistic targets for future quality improvement: continuity, cross-coverage and communication – the 'C' factors."
Research was conducted at Department of Surgery, Beth Israel Medical Center, New York, NY; Weill Medical College, Cornell University, New York, NY; Department of Education Development, Harvard Medical School, Boston, Mass.; Department of Pain Management and Palliative Care, Beth Israel Medical Center, New York, NY; Crawford Long Medical Center, Department of Obstetrics and Gynecology, Emory University School of Medicine, Atlanta, GA; and the Pediatric Otolaryngology Service, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Department of Otology and Laryngology, Harvard Medical School, Boston, Mass.
Research was funded by the Massachusetts Eye and Ear Infirmary, Boston, and Beth Israel Deaconess Medical Center, New York.
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