Patient safety in the era of the 80-hour workweek.
OBJECTIVE
In 2003, duty-hour regulations (DHR) were initially implemented for residents in the United States to improve patient safety and protect resident's well-being. The effect of DHR on patient safety remains unclear. The study objective was to evaluate the effect of DHR on patient safety.


METHODS
Using an interrupted time series analysis, we analyzed selected patient safety indicators (PSIs) for 376 million discharges in teaching (T) vs nonteaching (NT) hospitals before and after implementation of DHR in 2003 that restricted resident work hours to 80 hours per week. The PSIs evaluated were postoperative pulmonary embolus or deep venous thrombosis (PEDVT), iatrogenic pneumothorax (PTx), accidental puncture or laceration, postoperative wound dehiscence (WD), postoperative hemorrhage or hematoma, and postoperative physiologic or metabolic derangement. Propensity scores were used to adjust for differences in patient comorbidities between T and NT hospitals and between discharge quarters. The primary outcomes were differences in the PSI rates before and after DHR implementation. The PSI differences between T and NT institutions were the secondary outcome.


METHODS
T and NT hospitals in the United States.


METHODS
Participants were 376 million patient discharges from 1998 to 2007 in the Nationwide Inpatient Sample.


RESULTS
Declining rates of PTx in both T and NT hospitals preintervention slowed only in T hospitals postintervention (p = 0.04). Increasing PEDVT rates in both T and NT hospitals increased further only in NT hospitals (p = 0.01). There were no differences in the PSI rates over time for hemorrhage or hematoma, physiologic or metabolic derangement, accidental puncture or laceration, or WD. T hospitals had higher rates than NT hospitals both preintervention and postintervention for all the PSIs except WD.


CONCLUSIONS
Trends in rates for 2 of the 6 PSIs changed significantly after DHR implementation, with PTx rates worsening in T hospitals and PEDVT rates worsening in NT hospitals. Lack of consistent patterns of change suggests no measurable effect of the policy change on these PSIs.
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Julia
J
Shelton
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: kristy.l.kummerow@vanderbilt.edu.
Kristy
K
Kummerow
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Sharon
S
Phillips
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Patrick G
PG
Arbogast
Department of Preventive Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; Geriatric Research Education and Clinical Center, Tennessee Valley Healthcare System, VA Medical Center, Nashville, Tennessee.
Marie
M
Griffin
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Michael D
MD
Holzman
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
William
W
Nealon
Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
Benjamin K
BK
Poulose
D013502:General Surgery / Q000193:education*; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D065186:Interrupted Time Series Analysis; D061214:Patient Safety; D011030:Pneumothorax / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D018794:Problem-Based Learning; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D013529:Surgical Wound Dehiscence / Q000453:epidemiology; D020246:Venous Thrombosis / Q000453:epidemiology; D016526:Workload
Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; duty hours; internship and residency; patient safety; quality indicators