Patient Outcomes when Housestaff Exceed 80 Hours per Week.
It has been posited that high workload and long work hours for trainees could affect the quality and efficiency of patient care. Duty hour restrictions seek to balance patient care and resident education by limiting resident work hours. Through a retrospective cohort study, we investigated whether patient care on an inpatient general medicine service at a large academic medical center is impacted when housestaff work more than 80 hours per week.



We identified all admissions to a housestaff-run general medicine service between June 25, 2013 and June 29, 2014. Each hospitalization was classified by whether the patient was admitted by housestaff who have worked more than 80 hours per week during their hospitalization. Housestaff computer activity and duty hours were calculated by institutional electronic heath record audit, as well as length of stay and a composite of in-hospital mortality, intensive care unit (ICU) transfer rate, and 30-day readmission rate.



We identified 4767 hospitalizations by 3450 unique patients; of which 40.9% of hospitalizations were managed by housestaff who worked more than 80 hours that week during their hospitalization. There was a significantly higher rate of the composite outcome (19.2% vs 16.7%, P = .031) for patients admitted by housestaff working more than 80 hours per week during their hospitalization. We found a statistically significant higher length of stay (5.12 vs 4.66 days, P = .048) and rate of ICU transfer (3.53% vs 2.38%, P = .029). There was no statistically significant difference in 30-day readmission rate (13.7% vs 12.8%, P = .395) or in-hospital mortality rate (3.18% vs 2.42%, P = .115). There was no correlation with team census on admission and patient outcomes.



Patients taken care of by housestaff working more than 80 hours per week had increased length of stay and number of ICU transfers. There was no association between resident work-hours and patient in-hospital mortality or 30-day readmission rate.
Department of Internal Medicine, Stanford University School of Medicine, Calif.
David
D
Ouyang
Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Calif.
Jonathan H
JH
Chen
Stanford Center for Clinical Informatics, Stanford University School of Medicine, Calif.
Gomathi
G
Krishnan
Department of Internal Medicine, Stanford University School of Medicine, Calif.
Jason
J
Hom
Department of Internal Medicine, Stanford University School of Medicine, Calif.
Ronald
R
Witteles
Department of Internal Medicine, Stanford University School of Medicine, Calif. Electronic address: jeffrey.chi@stanford.edu.
Jeffrey
J
Chi
D003953:Diagnosis-Related Groups; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Duty hours; Electronic health record; Medical education; Readmissions