Changes in Hospital Mortality Associated with Residency Work-Hour Regulations: Shetty KD, Bhattacharya J. Ann Intern Med 2007;147:73–80

Abstract

This retrospective study compared mortality rates in teaching and non-teaching hospitals before and after the enforcement of Accreditation Council on Graduate Medical Education (ACGME) work-hour regulations on July 1, 2003. The goal of the study was to determine whether work-hour regulations impacted the mortality rates of hospitalized internal medicine and surgical patients. The authors selected a variety of high-risk diagnoses and tracked the mortality rates of patients admitted with these diagnoses from January 2001 to December 2004. These diagnoses represented 15% of all hospital admissions and 34% of all in-hospital deaths. The teaching vs. non-teaching designation was made based on whether the individual hospital housed a residency program for medicine or surgery. Changes in mortality rates over time were accounted for by using the mortality rates in non-teaching hospitals as the control group. The authors found a 0.25% absolute reduction in mortality (p = 0.043) and a 3.75% relative risk reduction for death among the 1,268,738 medical patients examined. The most impressive reductions were observed among patients admitted for congestive heart failure or infectious diseases, and in those with an age > 80 years. Of note, no significant differences were observed in the mortality rates of surgical patients. The authors conclude that the ACGME restrictions on work hours have improved outcomes in medical (but not surgical) patients.