Prolonged hospital stay and the resident duty hour rules of 2003.
BACKGROUND
Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care.


OBJECTIVE
We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge.


METHODS
Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site.


METHODS
Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005.


METHODS
Prolonged length of stay.


RESULTS
Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures.


CONCLUSIONS
Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.
Silber
Jeffrey H
JH
Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. silberj@wharton.upenn.edu
Rosenbaum
Paul R
PR
Rosen
Amy K
AK
Romano
Patrick S
PS
Itani
Kamal M F
KM
Cen
Liyi
L
Mi
Lanyu
L
Halenar
Michael J
MJ
Even-Shoshan
Orit
O
Volpp
Kevin G
KG
D000068:Accreditation; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data