R. Rajaram1,2, J. Chung2, A. Jones3, M. Cohen1, A. Dahlke2, L. Hedges4, C. Ko1,5, J. Tarpley6, F. Lewis3, D. Hoyt1, K. Bilimoria1,2 1American College Of Surgeons,Division Of Research And Optimal Patient Care,Chicago, IL, USA 2Northwestern University,Surgical Outcomes And Quality Improvement Center, Department Of Surgery And Center For Healthcare Studies In The Institute For Public Health And Medicine, Feinberg School Of Medicine,Chicago, IL, USA 3American Board Of Surgery Inc,Philadelphia, PA, USA 4Northwestern University,Institute For Policy Research And Department Of Biostatistics,Chicago, IL, USA 5University Of California – Los Angeles And VA Greater Los Angeles Healthcare System,Department Of Surgery,Los Angeles, CA, USA 6Vanderbilt University Medical Center,Department Of Surgery,Nashville, TN, USA
Introduction: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) furthered restrictions to existing resident duty hour requirements. However, it remains unknown whether these policies improved patient care or resident education or worsened them due to decreased continuity of care. The objectives of this study were to assess if implementation of the 2011 ACGME resident duty hour reform was associated with improvements in (1) surgical patient outcomes or (2) resident exam performance.
Methods: General surgery patients at teaching and non-teaching hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP; 2009/10 to 2012/13 academic years) were identified. Using a difference-in-differences approach, we evaluated outcomes in teaching hospitals compared to non-teaching hospitals for two years prior to and after the duty hour reform. We examined 6 patient outcomes with our primary outcome measure being Death/Serious Morbidity. Additionally, categorical general surgery resident performance on the American Board of Surgery in-training exam (ABSITE) and scores for first-time examinees on the written and oral board certification exams were compared with trend tests for this same time period.
Results: There were 204,641 patients were identified from 23 teaching (n=102,525) and 31 non-teaching (n=102,116) hospitals. The 2011 ACGME duty hour reform was not associated with a significant change in Death/Serious Morbidity (OR 1.06, 95% CI 0.94-1.20) or other adverse outcomes in teaching hospitals. Moreover, similar results were found when comparing adverse outcomes in teaching hospitals pre-reform to post-reform years 1 and 2 separately. A subgroup analysis of high-risk patients suggested that duty hour reform was significantly associated with an increase in Death/Serious Morbidity in the first year after the policy (OR 1.16, 95% CI 1.01-1.33) but not in the second year (OR 0.95, 95% CI 0.81-1.12). Written board exam pass rates improved significantly (83.0% to 87.9%, P < 0.001); however, there were no differences in ABSITE scores or oral board exam pass rates during this time period.
Conclusion: Implementation of the 2011 ACGME duty hour reform was not associated with improved general surgery patient outcomes or changes in resident ABSITE or oral board scores. Given concerns about continuity of care and resident education, consideration should be given to revising existing duty hour requirements.
