Life after 80 hours: the impact of resident work hours mandates on trauma and emergency experience and work effort for senior residents and faculty.
BACKGROUND
The purpose of this study was to evaluate the impact of work hours mandates on (1) senior resident patient exposure and operating experience in trauma and emergency surgery and (2) faculty work effort.


METHODS
We measured resident and faculty work on the trauma and emergency surgery services at our Level I trauma center during two comparable 6-month periods. Period 1 (July 1-December 31, 2002) had no call restrictions, separate trauma and emergency service resident call, and some overlap of faculty call responsibilities. Period 2 (July 1-December 31, 2003) had resident work hours compliance and complete integration of resident and faculty trauma and emergency call. Work hours were measured by surveys for faculty and residents. All data were collected prospectively.


RESULTS
Resident exposure to trauma patients was similar during both time periods. Emergency surgery admissions declined during period 2; however, intensive care unit admissions increased. The number of operations performed by senior residents did not change; however, there was a shift in the median number of emergency surgery cases to more senior residents. Faculty work hours increased slightly despite a decrease in faculty call.


CONCLUSIONS
Work hours compliance resulted in a 50% reduction in senior resident call and a 19% decrease in their work hours with no significant change in trauma/emergency patient care exposure or operative case load. Service call amalgamation reduced faculty call by 21% but did not result in a corresponding change in work hours or productivity.
Malangoni
Mark A
MA
Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center Campus, Cleveland, Ohio, USA. mmalangoni@metrohealth.org
Como
John J
JJ
Mancuso
Charlene
C
Yowler
Charles J
CJ
D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education / Q000458:organization & administration*; D005180:Faculty, Medical; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D007902:Length of Stay; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data*; D014194:Traumatology / Q000193:education / Q000458:organization & administration; D016526:Workload