title: The effect of new duty hours on resident academic performance and adult resuscitation outcomes.
abstract: BACKGROUND
  From July 2011, the Accreditation Council for Graduate Medical Education implemented new resident duty hours throughout the US. This study aimed to determine whether changes to call schedules due to these new duty hours achieved the intended goals of excellent patient care and improved resident learning.
  
  
  METHODS
  We conducted a retrospective cohort study at an academic hospital. For patient outcomes, we used the hospital registry for code blues and rapid responses to compare the proportion of deaths and transfers to an intensive care unit (July 2010 to June 2011; July 2011 to June 2012). For resident learning, we compared delta percentage scores for annual in-service training examinations (2009 to 2010; 2010 to 2011; 2011 to 2012).
  
  
  RESULTS
  We recorded 187 code blues and 469 rapid responses during the 2-year period: 48 (7.3%) deaths, 374 (57.0%) transfers to the intensive care unit, and 234 (35.7%) stabilizations on the floor. Of all transfers to the intensive care unit, those due to a code blue decreased after implementation of the new duty hours (36% [63/174] vs 25% [49/200], P = .02; adjusted odds ratio = 0.59; 95% confidence interval, 0.37-0.92). The median (interquartile range) delta percentage scores for annual in-service training examinations decreased significantly from the first time-period (2009 to 2010: 7 [4-11]) to the third time-period (2011 to 2012: 5 [2-8], P = .02).
  
  
  CONCLUSIONS
  We observed a reduced proportion of transfers to the intensive care unit with a code blue after implementation of new resident duty hours. Resident academic performance experienced a small but significant decrease in in-service training examination delta percentage score. We need large, multicenter studies to corroborate these findings.
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson. Electronic address: dominiquepepper@gmail.com.
authors.forename: Dominique J
authors.initials: DJ
authors.lastname: Pepper
authors.affiliation: Department of Emergency Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Michelle
authors.initials: M
authors.lastname: Schweinfurth
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Vincent E
authors.initials: VE
authors.lastname: Herrin
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*
keywords: ACGME; Emergency; Outcome; Resident; Resuscitation