Inpatient safety outcomes following the 2011 residency work-hour reform

Authors

  • Lauren Block MD, MPH,

    Corresponding author
    1. Division of General Internal Medicine, Hofstra North Shore–LIJ School of Medicine, Lake Success, New York
    2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    • Address for correspondence and reprint requests: Lauren Block, MD, Hofstra North Shore-LIJ School of Medicine, 2001 Marcus Ave, Suite S160, Lake Success NY 11042; Telephone: 516-519-5600; Fax: 516-519-5601; E-mail: lblock2@nshs.edu

    Search for more papers by this author
  • Marian Jarlenski MPH,

    1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    Search for more papers by this author
  • Albert W. Wu MD, MPH,

    1. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
    2. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for more papers by this author
  • Leonard Feldman MD,

    1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for more papers by this author
  • Joseph Conigliaro MD, MPH,

    1. Division of General Internal Medicine, Hofstra North Shore–LIJ School of Medicine, Lake Success, New York
    Search for more papers by this author
  • Jenna Swann MS,

    1. Johns Hopkins Health System, Baltimore, Maryland
    Search for more papers by this author
  • Sanjay V. Desai MD

    1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
    Search for more papers by this author

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. © 2014 Society of Hospital Medicine

Ancillary