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Limits On Resident Work Hours Do Not Improve Patient Mortality Rates

Armen Hareyan's picture

Patient Mortality Rates

Guidelines that limit medical residents to 80 work hours per week, which were implemented by the Accreditation Council for Graduate Medical Educationfour years ago in an effort to help reduce medical errors, have hadlittle effect on reducing patient mortality rates, according to twostudies published Wednesday in the Journal of the American Medical Association, AP/Long Island Newsday reports.

Thestudies analyzed data on 318,000 Veterans Affairs patients and morethan 8.5 million Medicare beneficiaries. Researchers led by KevinVolpp, a physician at the Philadelphia VA Medical Center,evaluated patient mortality rates within 30 days of admission athospitals across the U.S., reviewing outcomes both before and after theACGME policy was implemented. To assess the effects of the new rules,they compared death rates at hospitals with large numbers of residentswith those that had few residents.

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The first study examined VApatients being treated for heart attack, stroke, gastrointestinalbleeding or congestive heart failure. Researchers found that two yearsafter the new rules were implemented, mortality rates improved 11% to14% at major teaching hospitals compared with facilities that had fewmedical residents. No change in mortality rates was observed among VAsurgery patients. The second study involving Medicare beneficiariesfound no major changes in the death rates of medical or surgicalpatients at large teaching hospitals.


Volpp said he and his team were "a little surprised" about the findingsof the studies, adding, "We thought that mortality outcomes wouldimprove more consistently."

Ingrid Philibert, senior vicepresident for ACGME, said the lower death rate in the group of VApatients treated at major teaching hospitals is "a very significantfinding" that proves the policy works. Of the groups that showed nodifferences in mortality rates, she said, "It would be na