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The Impact of the 2011 ACGME Resident Duty Hour Reform on Trauma Care
*Jayson S Marwaha1,2, *Brian C Drolet1,2, *Suma S Maddox1, Charles A Adams, Jr1,2
1Rhode Island Hospital, Providence, RI;2Warren Alpert Medical School of Brown University, Providence, RI
Objective: In 2011 the Accreditation Council for Graduate Medical Education (ACGME) implemented new restrictions for resident duty hours to improve quality and safety of care. However, there is concern that limiting duty hours may be detrimental to resident education and continuity of care. We sought to evaluate the impact of the 2011 reform on trauma care.
Design: Retrospective cohort review. Setting: Academic Level 1 Trauma Center.
Patients: All trauma admissions from 7/1/2009 to 6/30/2013 - 11,740 patients. Patients were grouped into 2 sets: admissions before and after policy reform.
Interventions: None.
Main Outcome Measures: Primary: mortality, complications, length of stay. Secondary quality measures: number of procedures and OR visits, organ/space surgical site infections, return to OR, missed injuries, empyema after chest tube placement.
Results: Following 2011 restrictions, mortality was unchanged (5.67% to 5.74%; p=0.875) but secondary measures of quality demonstrated only negative trends. OR visits per patient increased (0.76 to 0.91; p<0.0001), representing an additional 944 operations. Number of procedures per patient increased (6.72 to 7.34; p<0.0001), representing 3810 additional procedures. After laparotomy, deep organ space surgical site infections increased (10.82% to 16.28%; p=0.067) and return to OR increased in patients with ISS >25 (8.33% to 18.82%; p<0.0001). Conclusions: There were significant findings in areas of resource utilization and complications after the 2011 reform. Procedural utilization increased most significantly in the least-severely injured patients, who are often managed by residents. Several other measures in which residents are central care providers also worsened. These findings suggest that duty hour limitations - which demonstrably increase hand-offs and may decrease resident experience - may negatively affect trauma care. These trends should be further examined on a national scale.
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