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Surgical Residents' Shift Length Not a Factor in Patient Safety

By John Commins  
   February 03, 2016

Concern that duty hour restrictions inhibit the ability of surgical residents to care for patients prompted researchers to design a trial to test the efficacy of duty hour policies.

Giving surgical residents the choice to work longer shifts or take less time off between shifts does not create greater risks of health complications or death for their patients, according to a study in Tuesday's edition of The New England Journal of Medicine.


Karl Bilimoria, MD

The first-ever national randomized trial of resident duty hours involving 117 general surgery residency programs and 151 hospitals found that less-restrictive policies are safe for patients, reduce complications arising from handoffs, and increase resident satisfaction, said study author Karl Bilimoria, MD. He is a faculty scholar at the American College of Surgeons and director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago.

"The study was developed due to persistent concerns in the surgical community because of the duty hour restrictions that had been implemented in 2003 and 2011," Bilimoria said in a conference call with media on Tuesday.

"There was concern that the restrictions actually inhibited continuity of care, or the ability of doctors to care for their patients [by] having to hand off care at inopportune times. The cumulative restrictions were forcing residents to leave in the middle of operations, or while stabilizing patients in the in the intensive care unit. Clearly that is bad for patients, but it is also bad for resident training."

The Accreditation Council for Graduate Medical Education in 2003 limited residents' work hours to 80 per week, capped overnight shift lengths, and mandated minimum time off between shifts. In 2011, ACGME further shortened shift lengths for first-year residents and increased residents' time off after a 24-hour shift.

The FIRST Trial
With the support of ACGME, the American Board of Surgery, and the American College of Surgeons, Bilimoria and his colleagues developed the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial to test the efficacy of these duty hour policies.

The study randomly assigned general surgery residency programs to use one of two types of duty hour policies during the academic year from July 1, 2014, to June 30, 2015. Both groups adhered to three main ACGME rules: The workweek was limited to 80 hours; one day off in seven was required; and residents could not take call more often than every third night.

A total of 117 programs at 151 hospitals completed the study.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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