Cutting Hospital Doctors Hours Doesn’t Affect Mortality

In the last decade there has been widespread concern about the large number of medical errors in US hospitals. In an effort to reduce these, limits were imposed on hospital residents’ hours in 2003. The limits set were no more than 80 hours a week, one day in 7 free of all duties, no more than 24 continuous hours (with an additional 6 hours for education), on-call at night no more often that every third night, and at least 10 hours of rest between duty periods. It was hoped that if doctors were less tired, they would make fewer errors.

The Journal of the American Medical Association contains reports of two studies of mortality rates in the years immediately following the institution of shorter hours. One study involving Medicare patients was done during the first 2 years in 3,300 US hospitals. There was no significant increase or decrease in mortality during this period compared with pre-reform years.

The other study was done in 130 Veterans Administration hospitals. There was no improvement or worsening of mortality rates in the VA patients overall, but there was a small saving of lives in patients with four common conditions – heart attack, heart failure, gastrointestinal bleeding, or stroke – in the second post-reform year.

The big drawback to these studies was that there was no information available on the actual number of hours worked. Residents are quite likely to ‘work overtime’ if the need exists, and are hardly likely to be able to make up time when things are quiet, as they rarely are quiet in a hospital. And a resident’s superior is in a strong position to demand extra hours from his or her underling. Nevertheless, the findings show that there was no measurable increase in mortality due to possible unavailability of enough physicians because of limited hours. I guess it’s a good result, all round.