Longer Shifts for Surgical Residents Deemed Safe

Researchers at Northwestern University (NU; Chicago, IL, USA), the University of California Los Angeles (UCLA; USA), and other institutions conducted a national survey involving 117 general surgery residency programs in the United States. The programs were randomly assigned to current Accreditation Council for Graduate Medical Education (ACGME) duty-hour policies (standard-policy group) or more flexible policies that waived rules on maximum shift lengths and time off between shifts (flexible-policy group).

Study outcomes included 30-day rates of postoperative death, serious postoperative complications, and resident perceptions and satisfaction regarding their well-being, education, and patient care. Data analysis from 138,691 patients showed that flexible, less-restrictive duty-hour policies were not associated with an increased rate of death or of any secondary postoperative outcomes. As to the 4,330 residents, those in programs assigned to flexible policies did not report significantly greater dissatisfaction with overall education quality or well-being.

Residents under flexible policies were less likely to perceive negative effects of duty-hour policies on multiple aspects of patient safety, continuity of care, professionalism, and resident education, but were more likely to perceive negative effects on personal activities. Residents in the flexible-policy group were also less likely than those in the standard-policy group to report leaving during an operation or handing off active patient issues. The study was presented at the Academic Surgical Congress, held during February 2, 2016, in Jacksonville (FL, USA).

“These results suggest flexible duty hours are safe for patients and beneficial for residents in numerous ways,” said lead author Karl Bilimoria, MD, of NU. “It’s counterintuitive to think it’s better for doctors to work longer hours; but when doctors have to hand off their patients to other doctors at dangerous, inopportune times, that creates vulnerability to the loss of critical information, a break in the doctor-patient relationship, and unsafe care.”

The 2011 ACGME duty hour rules include increased supervision, decreased work hours (especially for first year residents), and increased emphasis on the safe transfer of patient care during sign out. Main points include a maximum 80 hours work week averaged over a 4-week period, inclusive of in-house night calls, a maximum of 24 consecutive hours inclusive of morning and noon educational programs. Rotations in which trainee is assigned to emergency department duty shall ensure that trainees work no longer than 12 hour shifts.

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Northwestern University
University of California Los Angeles