title: How to increase the burden on trauma centers: implement the 80-hour work week.
abstract: The 80-hour week was implemented in 2003 to improve outcomes and limit errors. We hypothesize that there has been no change in outcomes postimplementation of the restrictions. Outcomes were queried from the trauma registry from 1997 to 2002 (PRE) and 2004 to 2009 (POST). Primary outcomes were mortality, intensive care unit length of stay (ICU LOS), and length of stay (LOS). Patients were stratified based on demographics, blood pressure, heart rate, and injury severity (Injury Severity Score, Glasgow Coma Score, base deficit). Outcomes were then compared PRE with POST. A total of 41,770 patients were admitted during the study period. The mean age was 38 years with most being male (73%) and blunt mechanism (78%). Although patients admitted in the POST period had a slightly higher blood pressure, they were older and had higher injury severity. ICU LOS, LOS, self-pay, and mortality were higher in the POST period. After adjusted analysis, admission in the POST period was no longer a predictor of mortality (odds ratio, 1.02; confidence interval, 0.92 to 1.14). Whereas patients were more slightly more injured in the POST period, the adjusted analysis shows no difference in mortality and both a longer LOS and ICU LOS. Whether the increase is the result of more severe injury in the POST period or less efficient disposition remains to be elucidated. This study adds to the mounting evidence that the implementation of the limits on work hours does not lead to better outcomes.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.forename: John P
authors.initials: JP
authors.lastname: Sharpe
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data / Q000639:trends*; D007396:Internship and Residency / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data / Q000639:trends*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013714:Tennessee; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D016526:Workload / Q000592:standards*