Implementation of Resident Work Hour Restrictions is Associated With a Reduction in Mortality and Provider-Related Complications on the Surgical Service

Abstract

To determine the effect of implementation of work hour restrictions on the rates of morbidity, mortality, and provider-related complications in surgical patients and to determine the incremental personnel costs associated with implementation. In 2003, the Accreditation Council for Graduate Medical Education enacted resident work hour restrictions (RWHR) to improve patient safety by decreasing errors attributed to resident fatigue. There are no quantitative data on surgical patients to validate whether this objective has been achieved and, if so, at what cost. Retrospective observational cohort analysis of data gathered concurrently with patient care for 30 days after admission or surgical intervention before implementation (prerestriction: July 2001-June 2003) and after (postrestriction: July 2005-June 2007). mortality, surgical complications, percentage of complications judged to be provider-related, and incremental personnel costs (salary and fringe of providers). A total of 14,610 patients were admitted during the 2 periods. Compared with the prerestriction period, there was a significant reduction in the percentage of complications attributed to providers (pre: 48.3%; post: 38.6%, P < 0.001) and a significant reduction in mortality rate (pre: 1.9%; post: 1.1%, P = 0.002) in the postrestriction period. Postrestriction the clinical care hours provided by attending surgeons increased significantly and was associated with a 1250% increase in the RVU-82 billing modifier ("no qualified resident available") from 523 RVUs pre-RWHR to 6542 post-RWHR. There was an increase in annual personnel costs postrestriction of $1.466 million. Implementation of RWHR was associated with reduced provider-related complications and mortality suggesting improved patient safety. This was likely due to several factors including reduced resident fatigue and greater attending involvement in clinical care.