Introduction: Perfecting the balance between patient safety and resident wellbeing is an ongoing process in the United States and in 2003, the ACGME implemented resident duty hour restrictions with these goals in mind. Using 10 years of post-reform data, we seek to elucidate the long-term impact of the ACGME duty hour restriction on patient mortality from Acute Ischemic Stroke.
Methods: Using the Nationwide Inpatient Sample data, we conducted a retrospective cohort study comparing the deaths per 1,000 adult patients admitted to teaching and non-teaching hospitals for AIS from 2000-2012. Trend analysis and two-proportion z-test were preformed with a p-value of 0.01 to identify differences in mortality rates of teaching and non-teaching hospitals by year.
Results: Over thirteen years, a total of 6,997,569 stroke discharges were recorded for this study. From 2000 to 2012 the mortality rate significantly decreased for both teaching and non-teaching hospitals by 4.35% and 3.44% respectively (p-value < 0.000). In the pre-reform period, teaching hospitals had a significantly greater mortality rate for AIS than non-teaching hospitals (p-value < 0.011). Mortality rates shifted in the peri-reform period with no-significant difference in 2002 and 2003. One year after ACGME duty hour policy, teaching hospitals again had a significantly greater mortality rate. However, throughout the entire post-reform period of 2005-2012 teaching hospitals had a significantly lower mortality rate than non-teaching hospitals for AIS.
Conclusions: Our results indicate that the ACGME duty hour restrictions had a positive impact on patient safety for AIS while reducing the weekly hours worked by residents. Both hospital types showed significant reduction in mortality rate over the 13 years. More research must be done to determine the long-term impact of ACGME restrictions on mortality rate for other common diseases and surgical procedures.
Patient Care: 10 years on, the debate over patient safety, resident wellbeing, and the ACGME duty hour restrictions is unresolved with little conclusive evidence. This study looks at their effect on mortality for specific disease using national data. In terms of patient care, it seems reducing resident work hours has a positive impact on patients suffering acute ischemic stroke. More research is needed to find the optimal balance between duty hours and patient outcomes.
Learning Objectives: By the conclusion of this session participants should be able to 1) Describe the importance of reducing resident duty work hours on the improvement in morality rate for acute ischemic stroke 2) Understand the national improvements in stroke recognition and treatment that lead to improved mortality rate overall in teaching and non-teaching hospitals 3) Discuss in small groups other diseases and surgical procedures that could be analyzed in a similar fashion to gain a broader understanding of how ACGME resident duty hour restrictions have affected patient mortality rates 4) Discuss in small groups the possibility that future research like this may indicate that there are differences in the amount of duty hours required for surgical versus medical residents in order to achieve improved patient safety.