BACKGROUND: The Accreditation Council for Graduate Medical Education reforms in 2003 instituted an 80-hour weekly limit for resident physicians. Critics argue that these restrictions have increased handoffs among residents and the potential for a decline in patient safety. "Never events" hospital-acquired conditions (HACs) are a set of preventable events used as a quality metric in hospital safety analyses. OBJECTIVE: This analysis evaluated post-work hour reform effects on HAC incidence for US hospital inpatients, using the National Inpatient Sample. METHODS: Data were collected from 2000-2002 (pre-2003) and 2004-2006 (post-2003) time periods. HAC incidence in academic and non-academic centers was evaluated in multivariate analysis assessing for likelihood of HAC occurrence, prolonged length of stay (pLOS), and increased total charges. RESULTS: The data encompassed approximately 111 million pre-2003 and 117 million post-2003 admissions. Patients were 10% more likely to incur a HAC in the post-2003 versus pre-2003 era (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.06-1.14; P < .01). Teaching hospitals exhibited an 18% (OR = 1.18; 95% CI 1.11-1.27; P < .01) increase in HAC likelihood, with no change in nonteaching settings (OR = 1.03; 95% CI 1.00-1.06; P > .05). Patients with ≥ 1 HAC were associated with a 60% likelihood of elevated charges (OR = 1.60; 95% CI 1.50-1.72; P < .01) and 65% likelihood of pLOS (OR = 1.65; 95% CI 1.60-1.70; P < .01). CONCLUSIONS: Post-2003 era patients were associated with 10% increased likelihood of HAC, with effects noted primarily at teaching hospitals.
BACKGROUND: The Accreditation Council for Graduate Medical Education reforms in 2003 instituted an 80-hour weekly limit for resident physicians. Critics argue that these restrictions have increased handoffs among residents and the potential for a decline in patient safety. "Never events" hospital-acquired conditions (HACs) are a set of preventable events used as a quality metric in hospital safety analyses. OBJECTIVE: This analysis evaluated post-work hour reform effects on HAC incidence for US hospital inpatients, using the National Inpatient Sample. METHODS: Data were collected from 2000-2002 (pre-2003) and 2004-2006 (post-2003) time periods. HAC incidence in academic and non-academic centers was evaluated in multivariate analysis assessing for likelihood of HAC occurrence, prolonged length of stay (pLOS), and increased total charges. RESULTS: The data encompassed approximately 111 million pre-2003 and 117 million post-2003 admissions. Patients were 10% more likely to incur a HAC in the post-2003 versus pre-2003 era (odds ratio [OR] = 1.10; 95% confidence interval [CI] 1.06-1.14; P < .01). Teaching hospitals exhibited an 18% (OR = 1.18; 95% CI 1.11-1.27; P < .01) increase in HAC likelihood, with no change in nonteaching settings (OR = 1.03; 95% CI 1.00-1.06; P > .05). Patients with ≥ 1 HAC were associated with a 60% likelihood of elevated charges (OR = 1.60; 95% CI 1.50-1.72; P < .01) and 65% likelihood of pLOS (OR = 1.65; 95% CI 1.60-1.70; P < .01). CONCLUSIONS: Post-2003 era patients were associated with 10% increased likelihood of HAC, with effects noted primarily at teaching hospitals.
Authors: Danny M Vaughn; Christopher L Stout; Beth L McCampbell; Joshua R Groves; Albert I Richardson; William K Thompson; Martin L Dalton; Don K Nakayama Journal: Am Surg Date: 2008-06 Impact factor: 0.688
Authors: Gregory A Joice; Christopher M Deibert; Max Kates; Benjamin A Spencer; James M McKiernan Journal: Urology Date: 2013-01-03 Impact factor: 2.649
Authors: Benjamin K Poulose; Wayne A Ray; Patrick G Arbogast; Jack Needleman; Peter I Buerhaus; Marie R Griffin; Naji N Abumrad; R Daniel Beauchamp; Michael D Holzman Journal: Ann Surg Date: 2005-06 Impact factor: 12.969
Authors: Jennifer L Schuberth; Tom A Elasy; Javed Butler; Robert Greevy; Theodore Speroff; Robert S Dittus; Christianne L Roumie Journal: Circulation Date: 2008-04-21 Impact factor: 29.690