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Study Suggests Resident Duty Hour Reform has No Systematic Impact on Patient Safety in Teaching Hospitals


  • The implementation of duty hour regulations did not have an overall systematic impact on potential safety-related events in either VA or non-VA (Medicare) hospitals of different teaching intensity.
  • In the few cases where there were statistically significant increases in the relative odds of developing a patient safety event, the increases were too small to be clinically meaningful.
  • In VA hospitals, there were no significant changes post-reform for the "Technical Care" or "Continuity of Care" composites, while "Other" composite rates increased in post-reform year two in more vs. less teaching-intensive hospitals. In non-VA (Medicare) hospitals, there were no significant changes in the "Continuity of Care" or "Other" composites post-reform. "Technical Care" composite rates increased in post-reform year one only and were no longer significant by year two.

Concerns about patient safety were a major reason why duty hour regulations were implemented by the Accreditation Council for Graduate Medical Education (ACGME) on July 1, 2003. Investigators sought to determine the association between ACGME duty hour rules and patient safety, as measured by the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators. This observational study focused on patients admitted to VA (n=826,047) and Medicare (n=13,367,273) acute-care hospitals, examining changes in patient safety events in more vs. less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform. The AHRQ patient safety indicators (PSIs) were specifically designed to capture potentially preventable events that compromise patient safety in the acute-care setting, such as complications following surgeries, procedures, or medical care. For this study, the PSIs were grouped into composites of care, such as "Continuity of Care" (e.g., post-operative sepsis), "Technical Care" (e.g., accidental puncture or laceration), and "Other" – mix of surgical and medical PSIs (e.g., iatrogenic pneumothorax).


  • These results are based on administrative data alone, which lack clinical detail and are subject to variability in coding practices across providers.

This study was partly funded through HSR&D. Dr. Rosen and Ms. Loveland are part of HSR&D’s Center for Health Quality, Outcomes and Economic Research in Bedford, MA. Mr. Halenar and Dr. Volpp are part of HSR&D’s Center for Health Equity Research and Promotion in Philadelphia, PA.

PubMed Logo Rosen AK, Loveland SA, Romano PS, Itani KM, Silber JH, Even-Shoshan OO, Halenar MJ, Teng Y, Zhu J, Volpp KG. Effects of Resident Duty Hour Reform on Surgical and Procedural Patient Safety Indicators Among Hospitalized Veterans Health Administration and Medicare Patients. Med Care. 2009 Jul;47(7):723-731.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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