Hippocrates Affirmed? Limiting Residents' Work Hours Does No Harm to Patients

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) required residency training programs to restrict the number of hours that housestaff worked. The work-hour rules included a limit of 80 hours per week, a maximum duty period of 30 hours, a minimum break of 10 hours between duty periods, and at least 1 day in 7 free from clinical and educational obligations (1). The rationale was that sleep deprivation and fatigue compromise clinical performance and education, and that, in the absence of self-regulation, the government would regulate residency training (2). By 2003, New York had already imposed work-hour limits for residents (3).

Work-hour requirements were met with skepticism, some alarm, and compliance (4). To comply, many internal medicine programs added “night float” or “day float” residents. The number of housestaff-to-housestaff transfers of responsibility for a patient's care increased, raising concerns that care would be fragmented and patients would be harmed as residents, increased in number but less familiar with their patients, struggled to finish their work and hand off the care of their patients within the work-hour limits.

Studies done before the ACGME rules, many from New York, suggested that inpatient mortality rates were unchanged after the reduction in work hours and that the effects on other patient safety indicators varied (5). After implementing the 2003 work-hour regulations, some internal medicine programs reported that patient care was suffering (6–8), but a randomized trial of reduced work hours for medical interns in the intensive care units of a major teaching hospital demonstrated significantly improved attentiveness to duties and fewer medical errors …