Changes in Outcomes for Hospitalized Patients after Regulations to Restrict Resident Doctors' Work Hours

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The summary below is from the full report titled "Changes in Outcomes for Internal Medicine Inpatients after Work-Hour Regulations." It is in the 17 July 2007 issue of Annals of Internal Medicine (volume 147, pages 97-103). The authors are L.I. Horwitz, M. Kosiborod, Z. Lin, and H.M. Krumholz.

What is the problem and what is known about it so far?

During training, doctors often work long hours and are "on call" (working through the night in the hospital) every few days. Over the past decade, concern about bad effects of these long working hours on patient care has increased. Regulations that limit working hours for doctors in training to 80 hours per week have been in effect in New York since the late 1980s. In July 2003, rules went into effect throughout the United States to restrict the number of hours that doctors in training can work. However, whether restriction of work hours is associated with better patient outcomes is unclear. Doctors who are well rested may be less likely to make errors than doctors who are tired. However, the increase in transfers of patients from one doctor to the next that results from decreasing work hours could make errors more likely.

Why did the researchers do this particular study?

To see whether patient outcomes improved or worsened with work-hour restrictions for doctors in training.

Who was studied?

Patients who were discharged from a single hospital between 1 July 2002 and 30 June 2004: 14,260 patients from an internal medicine teaching service and 6664 patients from an internal medicine nonteaching service. Doctors in training did not care for patients in the nonteaching service. This means that work-hour restrictions could not explain any changes that occurred in the nonteaching service.

How was the study done?

The researchers compared patient outcomes before and after the date that work-hour restrictions went into effect in the 2 services. If both services had similar changes, this would suggest that the work-hour restrictions did not have a relationship with patient outcomes. However, larger changes in the teaching service than in the nonteaching service could be due to changes in work hours.

What did the researchers find?

The teaching service had larger improvements in 3 of the 7 outcomes studied (frequency of intensive care use, discharge to home or a rehabilitation facility, and pharmacy actions to prevent medication errors). Changes were similar in both groups for other outcomes (length of hospitalization, readmission to the hospital, bad drug interactions, and in-hospital death).

What were the limitations of the study?

Other differences besides work-hour restrictions might explain differences in changes over time in the teaching and nonteaching service. This study looked at only a limited set of patient outcomes.

What are the implications of the study?

Work-hour restrictions for doctors in training were associated with improvements in some and with worsening of none of the 7 outcomes examined in the study.