title: Work Hour Reduction: Still Room for Improvement.
abstract: OBJECTIVE
  The effect of resident duty hour restrictions continues to yield conflicting results on patient outcomes. Failure to rescue (FTR), or death after a major complication, has become a topic of increasing quality assessment. The aim of this study is to evaluate the effect of duty hour restrictions on in-hospital mortality, complication rates, and FTR in patients suffering traumatic injuries.
  
  
  METHODS
  Data from the National Trauma Data Bank (NTDB) were retrospectively reviewed (Research Data Set 2007-2008 and version 7.2). Patients admitted to Level I or II teaching institutions were dichotomized into pre-duty hour restriction (2002-2003) and post-duty hour restriction (2007-2008) time periods. Patients who had nonsurvivable injuries (any region Abbreviated Injury Scale score = 6), died within 48 hours, or had missing data were excluded. Multivariate logistic regression was used to adjust for differences in patient characteristics and derive adjusted outcomes.
  
  
  METHODS
  Level I and II teaching institutions in the NTDB.
  
  
  METHODS
  All patients with trauma admitted to a Level I or II teaching institution between January 1, 2002 and June 30, 2003 and between January 1, 2007 and December 31, 2008.
  
  
  RESULTS
  Although overall adjusted in-hospital mortality was decreased (adjusted odds ratio [AOR] = 0.7, p < 0.001) in the post-duty hour restriction era, overall complications (AOR = 2.0, p < 0.001) and FTR (AOR = 2.0, p < 0.001) were significantly higher.
  
  
  CONCLUSIONS
  Although there may be some benefit to resident duty hour restrictions, there is still room for improvement in patient care. Individual institutions should carefully review their own complication data to identify preventable systems issues, such as poor handoffs, and opportunities for increased resident supervision.
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Douglas Z
authors: DZ
authors: Liou
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Galinos
authors: G
authors: Barmparas
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Megan
authors: M
authors: Harada
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Rex
authors: R
authors: Chung
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Nicolas
authors: N
authors: Melo
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: Eric.Ley@cshs.org.
authors: Eric J
authors: EJ
authors: Ley
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Ali
authors: A
authors: Salim
authors: Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Marko
authors: M
authors: Bukur
mesh_terms: D000328:Adult; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016526:Workload / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery; D055815:Young Adult
keywords: Patient Care; Practice-Based Learning and Improvement; Systems-Based Practice; education; failure to rescue; resident duty hour; trauma