کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
4306398 1289219 2015 9 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Early impact of the 2011 ACGME duty hour regulations on surgical outcomes
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی عمل جراحی
پیش نمایش صفحه اول مقاله
Early impact of the 2011 ACGME duty hour regulations on surgical outcomes
چکیده انگلیسی

BackgroundIn 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented additional restrictions on resident work hours. Although the impact of these restrictions on the education of surgical trainees has been examined, the effect on patient safety remains poorly understood.MethodsWe used national Medicare Claims data for patients undergoing general (n = 1,223,815) and vascular (n = 475,262) surgery procedures in the 3 years preceding the duty hour changes (January, 2009–June, 2011) and the 18 months thereafter (July, 2011–December, 2012). Hospitals were stratified into quintiles by teaching intensity using a resident to bed ratio. We utilized a difference-in-differences analytic technique, using nonteaching hospitals as a control group, to compare risk-adjusted 30-day mortality, serious morbidity, readmission, and failure to rescue (FTR) rates before and after the duty hour changes.ResultsAfter duty hour reform, no changes were seen in the measured outcomes when comparing teaching with nonteaching hospitals. Even when stratifying by teaching intensity, there were no differences. For example, at the highest intensity teaching hospitals (resident/bed ratio of ≥0.6), mortality rates before and after the duty hour changes were 4.2% and 4.0%, compared with 4.7% and 4.4% for nonteaching hospitals (relative risk [RR], 0.98; 95% CI, 0.89–1.07). Similarly, serious complication (RR, 1.02; 95% CI, 0.98–1.06), FTR (RR, 0.95; 95% CI, 0.87–1.04), and readmission (odds ratio, 1.00; 95% CI, 0.96–1.03) rates were unchanged.ConclusionIn Medicare beneficiaries undergoing surgery at teaching hospitals, outcomes have not improved since the 2011 ACGME duty hour regulations.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Surgery - Volume 158, Issue 6, December 2015, Pages 1453–1461
نویسندگان
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