Long hours for surgical residents don’t seem to put patients at risk when the doctors-in-training are allowed to work longer shifts, a new study finds.
In fact, patients likely benefit, especially if the residents stay with their patients through the end of an operation or help to stabilize them in critical situations, the study authors said.
“It’s counterintuitive to think it’s better for doctors to work longer hours,” said principal investigator Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago.
“But when doctors have to hand off their patients to other doctors at dangerous, inopportune times, that creates vulnerability to the loss of critical information, a break in the doctor-patient relationship and unsafe care,” he explained in a university news release.
There is ongoing debate about medical resident work hour limits. Some previous studies have suggested that resident duty hour limits introduced in 2003 and revised in 2011 by the Accreditation Council for Graduate Medical Education (ACGME) have led to worse outcomes for surgery patients, the study authors said.
Residents are limited to 80 work hours per week and their shifts are capped at 28 consecutive hours. The new study compared programs where surgery residents followed those restrictions or had the flexibility to work more than 28 hours at a time if they felt it was in the best interest of their patients.
The research included more than 4,300 residents in nearly 120 residency programs at 151 U.S. hospitals, and nearly 139,000 patients. Outcomes among patients were similar whether residents stuck to the ACGME restrictions or were able to work longer shifts if needed.
Surgical residents who worked longer shifts said doing so didn’t harm their health and improved the quality of their training and patient safety. They were half as likely to leave in the middle of an operation, to miss an operation on one of their patients, or to leave a patient at a critical moment, the study found.
Results from the study were presented Feb. 2 at the Academic Surgical Congress, and is scheduled to appear in the New England Journal of Medicine.
“These results suggest flexible duty hours are safe for patients and beneficial for residents in numerous ways,” Bilimoria said.
“Residents used the flexibility of their hours strategically at important times. We have had overwhelming support from surgical residents in favor of increased flexibility,” he added.
The findings suggest that the ACGME should revise its resident duty hour policies, Bilimoria said.
“As a patient, you want the person who knows you to take care of you through the really critical parts of your care,” he said. “Once you are stabilized or your operation is done, then the doctors can hand off your care in a responsible way.”
The U.S. Agency for Healthcare Research and Quality has more about residents’ work hours and patient care.