The 80-hour work guidelines and resident survey perceptions of quality.
OBJECTIVE
We hypothesized that resident fatigue error should improve, related to well-rested trainees as a direct cause/effect benefit. However, patient hospital care quality is multifactorial, so impact on patient care quality by changing only one variable for a single caregiver group was unknown.


METHODS
Convenience samples of 156 residents from three surgical specialties were administered a questionnaire in early 2004 addressing perceptions of patient care quality before and after the 80-h workweek. Additionally, residents recently under work-hour restrictions (Newly Restricted, NR) were compared to New York state trainees already regulated by work-hour restrictions (Previously Restricted, PR).


METHODS
Surgical residency training venues.


METHODS
Survey results; the level of significance for all tests was 0.05.


RESULTS
The participation response rate was 94.5%. Eighty-eight percent of respondents indicated by survey subjective impression that patient care quality was either unchanged (63%) or worse (26%) due to work-hour restrictions (P = 0.003). PR residents were more likely than NR residents to report unchanged or worse quality of care (P = 0.015). Residents overall did perceive improvement in some types of error with fewer fatigue-related errors (P < 0.001), e.g., medication (P < 0.001), judgment (P = 0.001), and dexterity (P = 0.013), subsequent to work-hour restrictions. However, more errors were perceived related to continuity of care (P < 0.001), miscommunication (P = 0.001), and cross-coverage availability (P = 0.001).


CONCLUSIONS
Despite an expected perception of improvement in fatigue-related errors, most participants (particularly PR residents) reported impressions that patient care quality had remained unchanged or had declined under the work-hour restrictions. Unresolved challenges with continuity of care, miscommunication, and cross-coverage availability are possible explanations. Mere work-hour reduction does not appear to improve patient care quality automatically nor to decrease the possibility for some types of error. Process interventions that specifically target trainee sign-out coverage constraints as part of a global reassessment will be important for future attempts to enhance quality hospital patient care.
Biller
C Katarina
CK
Department of Surgery, Beth Israel Medical Center, New York, New York, USA.
Antonacci
Anthony C
AC
Pelletier
Stephen
S
Homel
Peter
P
Spann
Cyril
C
Cunningham
Michael J
MJ
Eavey
Roland D
RD
D000328:Adult; D003266:Continuity of Patient Care / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D005221:Fatigue; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D019300:Medical Errors / Q000592:standards / Q000706:statistics & numerical data; D009518:New York; D011787:Quality of Health Care; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D016526:Workload / Q000331:legislation & jurisprudence / Q000592:standards*