Longer Work Shifts by Residents Don’t Raise Risk to Patients

Patient safety did not decline when first-year residents in dozens of U.S. adult hospitals worked shifts longer than 16 hours, according to research led by an expert in outcomes research at Children’s Hospital of Philadelphia (CHOP).

Jeffrey H. Silber, MD, PhD, Director of CHOP’s Center for Outcomes Research led a collaborative study published March 7 in the New England Journal of Medicine. He said the carefully designed study offered “reassuring evidence that a more flexible approach to shift length does not pose significant risks to patients, compared to the conventional duty hours approach.”

Silber, along with colleagues from the Perelman School of Medicine at the University of Pennsylvania and other academic medical centers, analyzed data as part of the iCOMPARE Research Group, funded by the National Institutes of Health and the Accreditation Council for Graduate Medical Education (ACGME).

In 2011, the ACGME in 2011 established standards that limited first-year residents to work shifts of 16 hours per day and 80 hours per week. The researchers compared patient outcomes under those shift limits to outcomes under a system that allowed longer work shifts within the overall 80-hour weekly limit. iCOMPARE included data from 63 different internal-medicine residency programs throughout the U.S. between 2015 and 2016. Half the residency programs use the standard duty hours; the other half had flexible duty rules.

Overall, there was no significant difference between either group in patient mortality over 30 days. Likewise there were no adverse effects on other patient safety outcomes. Silber was a co-author of a companion iCOMPARE study in the same issue of the journal, led by Penn Medicine’s Mathias Basner, MD, PhD, which found that the residents in both groups did not differ in measures of sleep loss, sleepiness or alertness.

To read more about this study, see this press release from Penn Medicine.