2011 ACGME duty hour regulations may negatively impact continuity of care, quality of care, and educational opportunities for interns

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1. 2011 ACGME duty hour regulations significantly increase on-call sleep duration for interns compared to 2003 regulations

2. The findings suggest potential negative impacts on the continuity of patient care, the perceived quality of care, and the availability of educational opportunities

The findings of this study suggest that the 2011 ACGME duty hour regulations may negative impacts on the continuity of patient care, perceptions of quality of care, and educational opportunities, despite significantly increasing sleep duration for interns while on-call. These findings are consistent with other studies regarding duty hour regulations. Moreover, other studies assessing duty hour restrictions have not demonstrated the expected improvements in patient outcomes and safety. Limitations of this study include the fact that this study was conducted at a single centre, it involved only general internal medicine teams, and these findings may be impacted by unfamiliarity with the new models and resistance to change. Nevertheless, such a study cannot be repeated because 2003-compliant models are no longer acceptable.

Please click to read study in JAMA

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1. 2011 ACGME duty hour regulations significantly increase on-call sleep duration for interns compared to 2003 regulations

2. The findings suggest potential negative impacts on the continuity of patient care, the perceived quality of care, and the availability of educational opportunities

This [prospective, crossover, controlled] study: The Accreditation Council for Graduate Medical Education (ACGME) released new duty hour regulations in 2011 that mandate rest periods between duty periods, increased supervision for junior trainees, and a 16-hour limit on continuous duty hours for postgraduate year 1 (PGY-1) trainees (i.e., interns). The purpose of this study was to compare the effects of the 2011 regulations with the standards mandated in 2003 by the ACGME on sleep duration (both on- and post-call), trainee education, continuity of patient care, and perceived quality of care. The study involved four general internal medicine teams at The Johns Hopkins Hospital in Baltimore, Maryland, and took place over two 4-week periods in 2011. The study randomly assigned these teams using a crossover design to either a 2003-compliant control model (i.e., 30-hour limit for call every fourth night) or one of two 2011-compliant models (i.e., call every fifth night (Q5) or a night float system (NF), each with 16-hour call limits). The primary outcome of sleep duration was measured using wristwatch actigraphy, which was then analyzed using computer algorithms to calculate total sleep time.

The study involved 43 interns, and 26 PGY-2 and PGY-3 residents. A total of 843 hospital admissions were completed during the study timeframe. During 48-hour on-call periods (i.e., on-call and post-call days), interns in the control model did not sleep significantly less than ones in the Q5 or NF models. Control interns, however, did sleep significantly less than NF interns during the on-call period (5.1 vs. 8.3 hours), and slept significantly less than Q5 residents during the post-call period (7.5 vs. 10.2 hours). With regards to educational opportunities, interns in the Q5 and NF groups were responsible for significantly fewer admissions and had fewer teaching opportunities compared to control interns. In the experimental models, there were more handoffs between medical house staff, lower trainee satisfaction, and lower perceived quality of care by nurses and interns when compared to the control model.

In sum: The findings of this study suggest that the 2011 ACGME duty hour regulations may negative impacts on the continuity of patient care, perceptions of quality of care, and educational opportunities, despite significantly increasing sleep duration for interns while on-call. These findings are consistent with other studies regarding duty hour regulations. Moreover, other studies assessing duty hour restrictions have not demonstrated the expected improvements in patient outcomes and safety. Limitations of this study include the fact that this study was conducted at a single centre, it involved only general internal medicine teams, and these findings may be impacted by unfamiliarity with the new models and resistance to change. Nevertheless, such a study cannot be repeated because 2003-compliant models are no longer acceptable.

Please click to read study in JAMA

Written by Adrienne Cheung and Andrew Cheung

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