title: Inpatient safety outcomes following the 2011 residency work-hour reform.
abstract: BACKGROUND
  The impact of the 2011 residency work-hour reforms on patient safety is not known.
  
  
  OBJECTIVE
  To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center.
  
  
  METHODS
  Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes.
  
  
  METHODS
  All adult patients discharged from general medicine services from July 2008 through June 2012.
  
  
  METHODS
  Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index.
  
  
  RESULTS
  Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes.
  
  
  CONCLUSIONS
  In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety.
authors.affiliation: Division of General Internal Medicine, Hofstra North Shore-LIJ School of Medicine, Lake Success, New York; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lauren
authors.initials: L
authors.lastname: Block
authors.forename: Marian
authors.initials: M
authors.lastname: Jarlenski
authors.forename: Albert W
authors.initials: AW
authors.lastname: Wu
authors.forename: Leonard
authors.initials: L
authors.lastname: Feldman
authors.forename: Joseph
authors.initials: J
authors.lastname: Conigliaro
authors.forename: Jenna
authors.initials: J
authors.lastname: Swann
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000331:legislation & jurisprudence / Q000592:standards*; D008297:Male; D008875:Middle Aged; D061214:Patient Safety / Q000592:standards*; D010561:Personnel Staffing and Scheduling / Q000331:legislation & jurisprudence / Q000592:standards*; D012189:Retrospective Studies; D016526:Workload / Q000592:standards*