Limit on Doctors’ Hours Does Not Cut Mortality Rates, Studies Find

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

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

The first study examined VA patients being treated for heart attack, stroke, gastrointestinal bleeding or congestive heart failure.

Researchers found that two years after the new rules were implemented, mortality rates improved 11% to 14% at major teaching hospitals compared with facilities that had few medical residents. No change in mortality rates was observed among VA surgery patients.

The second study involving Medicare beneficiaries found no major changes in the death rates of medical or surgical patients at large teaching hospitals.

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

Ingrid Philibert, senior vice president for ACGME, said the lower death rate in the group of VA patients treated at major teaching hospitals is "a very significant finding" that proves the policy works. Of the groups that showed no differences in mortality rates, she said, "It would be naïve to expect that changing one input would produce a vast difference in outcomes."

However, the University of Chicago's David Meltzer, co-author of an accompanying editorial on the two studies, said the results give an overall sense that "there just wasn't any big effect on mortality one way or the other." He added, "There may be much better solutions than the one we've come up with" (Matheson, AP/Long Island Newsday, 9/4).