Received from Medical Scientist Training Program, Johns Hopkins University School of Medicine and the Department of Epidemiology (DLH), Johns Hopkins Bloomberg School of Public Health, Baltimore, Md; Center for Outcomes Research, The Children's Hospital of Philadelphia and the Departments of Pediatrics and Anesthesia (JHS), University of Pennsylvania School of Medicine, Philadelphia, Pa; and The Children's Hospital of Philadelphia, The Hospital of the University of Pennsylvania, and the Department of Anesthesia (DRJ), University of Pennsylvania School of Medicine, Philadelphia, Pa.
Do Regulations Limiting Residents’ Work Hours Affect Patient Mortality?
Article first published online: 28 JAN 2004
Journal of General Internal Medicine
Volume 19, Issue 1, pages 1–7, January 2004
How to Cite
Howard, D. L., Silber, J. H. and Jobes, D. R. (2004), Do Regulations Limiting Residents’ Work Hours Affect Patient Mortality?. Journal of General Internal Medicine, 19: 1–7. doi: 10.1111/j.1525-1497.2004.30336.x
- Issue published online: 28 JAN 2004
- Article first published online: 28 JAN 2004
- work hours
OBJECTIVE: To conduct a statewide analysis of the effect of New York's regulations, limiting internal medicine and family practice residents’ work hours, on patient mortality.
DESIGN: Retrospective study of inpatient discharge files for 1988 (before the regulations) and 1991 (after the regulations).
SETTING AND PATIENTS: Adult patients discharged from New York teaching hospitals (170,214) and nonteaching hospitals (143,455) with a principal diagnosis of congestive heart failure, acute myocardial infarction, or pneumonia, for the years 1988 and 1991 (periods before and after Code 405 regulations went into law). Patients from nonteaching hospitals served as controls.
MEASUREMENT: In-hospital mortality.
RESULTS: Combined unadjusted mortality for congestive heart failure, acute myocardial infarction, and pneumonia patients declined between 1988 and 1991 in both teaching (14.1% to 13.0%; P = .0001) and nonteaching hospitals (14.0% to 12.5%; P = .0001). Adjusted mortality also declined between 1988 and 1991 in both teaching (odds ratio [OR], death 1991/1988, 0.868; 95% confidence interval [CI], 0.843 to 0.894; P = .0001) and nonteaching hospitals (OR, death 1991/1988, 0.853; 95% CI, 0.826 to 0.881; P = .0001). This beneficial trend toward lower mortality over time was nearly identical between teaching and nonteaching hospitals (P = .4348).
CONCLUSION: New York's mandated limitations on residents’ work hours do not appear to have positively or negatively affected in-hospital mortality from congestive heart failure, acute myocardial infarction, or pneumonia in teaching hospitals.