Inpatient safety outcomes following the 2011 residency work-hour reform

Lauren Block, Marian Jarlenski, Albert W Wu, Leonard Feldman, Joseph Conigliaro, Jenna Swann, Sanjay Virendra Desai

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The impact of the 2011 residency work-hour reforms on patient safety is not known. OBJECTIVE: To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center. DESIGN: Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes. PATIENTS: All adult patients discharged from general medicine services from July 2008 through June 2012. MEASUREMENTS: Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index. RESULTS: Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes. CONCLUSIONS: In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety. Journal of Hospital Medicine 2014;9:347-352.

Original languageEnglish (US)
Pages (from-to)347-352
Number of pages6
JournalJournal of Hospital Medicine
Volume9
Issue number6
DOIs
StatePublished - 2014

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Internship and Residency
Inpatients
Hospitalists
Patient Safety
Safety
Intensive Care Units
Iatrogenic Disease
Confidence Intervals
Hospital Medicine
Diagnosis-Related Groups
Observational Studies
Length of Stay
Medicine
Mortality

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management
  • Medicine(all)

Cite this

Inpatient safety outcomes following the 2011 residency work-hour reform. / Block, Lauren; Jarlenski, Marian; Wu, Albert W; Feldman, Leonard; Conigliaro, Joseph; Swann, Jenna; Desai, Sanjay Virendra.

In: Journal of Hospital Medicine, Vol. 9, No. 6, 2014, p. 347-352.

Research output: Contribution to journalArticle

Block, Lauren ; Jarlenski, Marian ; Wu, Albert W ; Feldman, Leonard ; Conigliaro, Joseph ; Swann, Jenna ; Desai, Sanjay Virendra. / Inpatient safety outcomes following the 2011 residency work-hour reform. In: Journal of Hospital Medicine. 2014 ; Vol. 9, No. 6. pp. 347-352.
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AB - BACKGROUND: The impact of the 2011 residency work-hour reforms on patient safety is not known. OBJECTIVE: To evaluate the association between implementation of the 2011 reforms and patient safety outcomes at a large academic medical center. DESIGN: Observational study using difference-in-differences estimation strategy to evaluate whether safety outcomes improved among patients discharged from resident and hospitalist (nonresident) services before (2008-2011) and after (2011-2012) residency work-hour changes. PATIENTS: All adult patients discharged from general medicine services from July 2008 through June 2012. MEASUREMENTS: Outcomes evaluated included length of stay, 30-day readmission, intensive care unit (ICU) admission, inpatient mortality, and presence of Maryland Hospital Acquired Conditions. Independent variables included time period (pre- vs postreform), resident versus hospitalist service, patient age at admission, race, gender, and case mix index. RESULTS: Patients discharged from the resident services in the postreform period had higher likelihood of an ICU stay (5.7% vs 4.5%, difference 1.4%; 95% confidence interval [CI]: 0.5% to 2.2%), and lower likelihood of 30-day readmission (17.2% vs 20.1%, difference 2.8%; 95 % CI: 1.3 to 4.3%) than patients discharged from the resident services in the prereform period. Comparing pre- and postreform periods on the resident and hospitalist services, there were no significant differences in patient safety outcomes. CONCLUSIONS: In the first year after implementation of the 2011 work-hour reforms relative to prior years, we found no change in patient safety outcomes in patients treated by residents compared with patients treated by hospitalists. Further study of the long-term impact of residency work-hour reforms is indicated to ensure improvement in patient safety. Journal of Hospital Medicine 2014;9:347-352.

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