Citation

Matulewicz RS, Odell DD, Chung JW, Ban KA, Yang AD, Bilimoria KY. J. Am. Coll. Surg. 2016; 224(2): 113-117.e4.

Affiliation

Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; American College of Surgeons, Chicago, IL. Electronic address: k-bilimoria@northwestern.edu.

Copyright

(Copyright © 2016, American College of Surgeons, Publisher Elsevier Publishing)

DOI

10.1016/j.jamcollsurg.2016.10.044

PMID

27884803

Abstract

BACKGROUND: Residents are often required to balance whether to adhere to duty hour policies or violate them to care for patients and obtain educational experiences. Little is known about why residents violate duty hour policies and whether there is a relationship between how often residents violate duty hours and concerns about patient safety. Our objective was to assess the association between resident duty hour violations and resident concerns about patient safety. STUDY DESIGN: We analyzed survey data collected from surgery residents who completed the 2015 ABSITE, excluding those in the Flexible Policy arm of the FIRST Trial. Perceptions of how duty hour restrictions affect patient safety were dichotomized as either "positive/neutral" or "negative." Resident duty hour violations in a typical month were separated as "frequently" (≥3 times) or "infrequently" (<3 times). Rates were compared and regression models were used to examine the association between negative perceptions and duty hour violations, adjusting for resident and program-level covariates.

RESULTS: Overall, 25.3% of trainees under current policies perceived that current ACGME duty hour policies negatively affected patient safety. This negative perception increased with PGY level (PGY1:18.5%, PGY2-3:22.6%, PGY4-5:32.0%; p<0.001). Residents with negative perceptions more often reported frequent duty violations (positive/neutral:20.0% vs. negative:32.7%, p<0.001). After adjustment for covariates, a negative perception of how duty hour policies affect patient safety was significantly associated with a higher likelihood of frequent duty hour violations among all trainees grouped together (OR 1.89, 95%CI 1.60-2.22), and separately for interns (OR 2.59, 95%CI 1.70-3.93), junior (OR 1.62, 95%CI 1.22-2.16), and senior residents (OR 1.99, 95%CI 1.54-2.58).

CONCLUSION: Trainees who reported perceiving negative effects of duty hour policies on patient safety were more likely to report frequent duty hour violations.

Copyright © 2016. Published by Elsevier Inc.

Language: en