Resident Work Hour Limits and Patient Safety

In Brief Objective: This study evaluates the effect of resident physician work hour limits on surgical patient safety. Background: Resident work hour limits have been enforced in New York State since 1998 and nationwide from 2003. A primary assumption of these limits is that these changes will improve patient safety. We examined effects of this policy in New York on standardized surgical Patient Safety Indicators (PSIs). Methods: An interrupted time series analysis was performed using 1995 to 2001 Nationwide Inpatient Sample data. The intervention studied was resident work hour limit enforcement in New York teaching hospitals. PSIs included rates of accidental puncture or laceration (APL), postoperative pulmonary embolus or deep venous thrombosis (PEDVT), foreign body left during procedure (FB), iatrogenic pneumothorax (PTX), and postoperative wound dehiscence (WD). PSI trends were compared pre- versus postintervention in New York teaching hospitals and in 2 control groups: New York nonteaching hospitals and California teaching hospitals. Results: A mean of 2.6 million New York discharges per year wereanalyzed with cumulative events of 33,756 (APL), 36,970 (PEDVT), 1,447 (FB), 10,727 (PTX), and 2,520 (WD). Increased rates over time (expressed per 1000 discharges each quarter) were observed in both APL (0.15, 95% confidence interval, 0.09–0.20, P<0.05) and PEDVT (0.43, 95% confidence interval, 0.03–0.83, P<0.05) after policy enforcement in New York teaching hospitals. No changes were observed in either control group for these events or New York teaching hospital rates of FB, PTX, or WD. Conclusions: Resident work hour limits in New York teaching hospitals were not associated with improvements in surgical patient safety measures, with worsening trends observed in APL and PEDVT corresponding with enforcement. Resident physician work hour limits have been implemented in New York State at great cost and effort with a primary assumption of patient safety improvement. We present the first population-based evaluation of this policy using standardized surgical Patient Safety Indicators. Worsening trends in accidental puncture or lacerations and postoperative pulmonary embolus or deep venous thrombosis were observed in New York teaching hospitals after work hour limit enforcement.