Resident work hour limits in New York teaching hospitals were not associated with improved safety for surgery patients

2005 ◽  
Keyword(s):  
New York ◽  
Teaching Hospitals ◽  
Resident Work ◽  
Work Hour

Resident work hour regulations: comments from New York

2003 ◽  
Vol 60 (3) ◽  
pp. 271-273 ◽  
Author(s):  
Lynn Chao ◽  
Marc K. Wallack
Keyword(s):  
New York ◽  
Resident Work ◽  
Work Hour

scholarly journals The July Effect on Maternal Peripartum Complications before and after Resident Duty Hour Reform: A Population-Based Retrospective Cohort Study

2017 ◽  
Vol 34 (08) ◽  
pp. 818-825 ◽  
Author(s):  
Ithan Peltan ◽  
Crystal Brown ◽  
Alson Burke ◽  
Eric Chow ◽  
Ali Rowhani-Rahbar ◽  
...  
Keyword(s):  
Cohort Study ◽  
Population Based ◽  
Teaching Hospitals ◽  
Complication Risk ◽  
Resident Work ◽  
July Effect ◽  
Before And After ◽  
Work Hour ◽  
The Impact ◽  
Academic Year

Objective To compare maternal birth complications early versus late in the academic year and to evaluate the impact of resident work hour limitation on the “July effect.” Study Design We conducted a retrospective, population-based cohort study of 628,414 singleton births in Washington State from 1987 to 2012 measuring the adjusted risk of maternal peripartum complications early (July/August) versus late (April/May) in the academic year. To control for seasonal outcome variation unrelated to trainees' involvement in care as well as long-term trends in maternal complications unrelated to variation in trainees' effect on outcomes across the academic year, we employed difference-in-differences methods contrasting outcomes at teaching to nonteaching hospitals for deliveries before and after restriction of resident work hours in July 2003. Results Prior to resident work hour limitation in July 2003, women delivering early in the academic year at teaching hospitals suffered more complications (relative risk [RR] 1.05; 95% confidence interval [CI]: 1.00–1.09; p = 0.03). After July 2003, complication risk did not vary significantly across the academic year except at teaching-intensive hospitals, where July/August deliveries experienced fewer complications (RR: 0.95; 95% CI: 0.92–0.98; p = 0.001). Conclusion Women delivering at teaching hospitals early in the academic year suffered a modest but significant increase in complications before but not after resident work hour reform.

Implementing Resident Work Hour Limitations: Lessons From the New York State Experience

2003 ◽  
Vol 58 (8) ◽  
pp. 531-532
Author(s):  
Edward E. Whang ◽  
Michelle M. Mello ◽  
Stanley W. Ashley ◽  
Michael J. Zinner
Keyword(s):  
New York ◽  
New York State ◽  
York State ◽  
Resident Work ◽  
Work Hour ◽  
State Experience

scholarly journals Controlling a Multicenter Outbreak Involving the New York/Japan Methicillin-ResistantStaphylococcus aureusClone

2007 ◽  
Vol 28 (7) ◽  
pp. 845-852 ◽  
Author(s):  
G. W. Coombs ◽  
H. Van Gessel ◽  
J. C. Pearson ◽  
M.-R. Godsell ◽  
F. G. O'Brien ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Molecular Typing ◽  
Management Strategies ◽  
Research Unit ◽  
Management Policy ◽  
Teaching Hospitals ◽  
Term Care ◽  
Outbreak Management ◽  
Healthcare Facilities

Objective.To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistantStaphylococcus aureus(MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility.Setting.A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region.Interventions.A comprehensive, statewide MRSA epidemiological investigation and management policy.Results.In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread.Conclusions.The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.

scholarly journals Too Little Time to Teach? Medical Student Education and the Resident Work-Hour Restriction

2007 ◽  
Vol 172 (10) ◽  
pp. 1053-1057 ◽  
Author(s):  
Christopher M. Zahn ◽  
Susan G. Dunlow ◽  
Ruben Alvero ◽  
Jason D. Parker ◽  
M. Catherine Nace ◽  
...  
Keyword(s):  
Medical Student ◽  
Medical Student Education ◽  
Student Education ◽  
Resident Work ◽  
Work Hour

scholarly journals Thirty-Day Readmissions in Patients With Metastatic Cancer: Room for Improvement?

2019 ◽  
Vol 15 (5) ◽  
pp. e410-e419 ◽  
Author(s):  
Rachel Solomon ◽  
Natalia Egorova ◽  
Kerin Adelson ◽  
Cardinale B. Smith ◽  
Rebeca Franco ◽  
...  
Keyword(s):  
New York ◽  
Metastatic Cancer ◽  
Private Insurance ◽  
New York State ◽  
Skilled Nursing Facility ◽  
Teaching Hospitals ◽  
Readmission Rates ◽  
Data Set ◽  
Discharge Disposition ◽  
Discharge Home

Purpose: Cancer, with readmission rates as high as 27%, has thus far been excluded from most readmission reduction efforts. However, some readmissions for patients with advanced disease may be avoidable. We assessed the prevalence of potentially preventable readmissions and associated factors in patients with metastatic cancer. Patients and Methods: Using a merged longitudinal data set of New York State hospital discharges and vital records, we measured 30-day readmissions for anemia, dehydration, diarrhea, emesis, fever, nausea, neutropenia, pain, pneumonia, and sepsis among patients with metastatic cancer between 2012 and 2014. We used competing-risk models to assess the effects of demographics, comorbidities, hospital type, payer, and discharge disposition. Results: A total of 11,275 patients had 19,307 hospitalizations. The 30-day readmission rate was 24.5%; 11.9% (n = 565) of readmissions were potentially preventable. Higher readmission rates occurred in black (hazard rate [HR], 1.26; 95% CI, 1.17 to 1.35), Hispanic (HR, 1.19; 95% CI, 1.09 to 1.31), and younger patients (HR per 10 years, 0.94; 95% CI, 0.90 to 0.97). Lower rates were associated with female sex (HR, 0.95; 95% CI, 0.91 to 0.99), private insurance (HR, 0.87; 95% CI, 0.87 to 0.81), teaching hospitals, and hospice discharge (HR, 0.62; 95% CI, 0.42 to 0.91). Discharge home with services (HR, 1.21; 95% CI, 1.14 to 1.27) or to a skilled nursing facility (HR, 1.11; 95% CI, 1.01 to 1.23) increased readmission likelihood. Potentially preventable readmissions were associated with younger age (HR per 10 years, 0.98; 95% CI, 0.98 to 0.99) and discharge home with services (HR, 1.25; 95% CI, 1.04 to 1.50). Likelihood decreased if care was received at a teaching hospital (HR, 0.76; 95% CI, 0.59 to 0.99). Payer, sex, race, and comorbidities did not contribute. Conclusion: Although the overall rate of potentially preventable readmissions among patients with metastatic cancer is low, higher readmission rates among those discharged home with help suggest that services supplied may not be sufficient to address health needs.

Are Resident Work-Hour Limitations Beneficial to the Trauma Profession?

2006 ◽  
Vol 72 (1) ◽  
pp. 35-41 ◽  
Author(s):  
Tara Abraham ◽  
Marilee Freitas ◽  
Spiros Frangos ◽  
Heidi L. Frankel ◽  
Reuven Rabinovici
Keyword(s):  
General Surgery ◽  
National Level ◽  
Work Hours ◽  
Emergency General Surgery ◽  
Duty Hours ◽  
Likert Score ◽  
Resident Work ◽  
Work Hour ◽  
Resident Duty ◽  
Level I

In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts >30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 ± 0.5 vs Likert score 2.5 ± 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with <1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.

scholarly journals What Is Known: Examining the Empirical Literature in Resident Work Hours Using 30 Influential Articles

2016 ◽  
Vol 8 (5) ◽  
pp. 795-805 ◽  
Author(s):  
Ingrid Philibert
Keyword(s):  
Patient Safety ◽  
Scientific Literature ◽  
Well Being ◽  
Work Hours ◽  
Small Samples ◽  
Empirical Literature ◽  
Future Research ◽  
Resident Work ◽  
Work Hour ◽  
The Impact

ABSTRACT Background  Examining influential, highly cited articles can show the advancement of knowledge about the effect of resident physicians' long work hours, as well as the benefits and drawbacks of work hour limits. Objective  A narrative review of 30 articles, selected for their contribution to the literature, explored outcomes of interest in the research on work hours—including patient safety, learning, and resident well-being. Methods  Articles were selected from a comprehensive review. Citation volume, quality, and contribution to the evolving thinking on work hours and to the Accreditation Council for Graduate Medical Education standards were assessed. Results  Duty hour limits are supported by the scientific literature, particularly limits on weekly hours and reducing the frequency of overnight call. The literature shows declining hours and call frequency over 4 decades of study, although the impact on patient safety, learning, and resident well-being is not clear. The review highlighted limitations of the scientific literature on resident hours, including small samples and reduced generalizability for intervention studies, and the inability to rule out confounders in large studies using administrative data. Key areas remain underinvestigated, and accepted methodology is challenged when assessing the impact of interventions on the multiple outcomes of interest. Conclusions  The influential literature, while showing the beneficial effect of work hour limits, does not answer all questions of interest in determining optimal limits on resident hours. Future research should use methods that permit a broader, collective examination of the multiple, often competing attributes of the learning environment that collectively promote patient safety and resident learning and well-being.

Trauma Teams and Their Use in Aircraft Disasters

1985 ◽  
Vol 1 (2) ◽  
pp. 142-143
Author(s):  
Leon D. Star ◽  
Louis R.M. DelGuercio ◽  
Louis C. Abelson
Keyword(s):  
New York ◽  
Road Traffic ◽  
Trauma Team ◽  
Time Of Day ◽  
Teaching Hospitals ◽  
Mass Casualties ◽  
Medical College ◽  
Access Road ◽  
Major Teaching ◽  
Trauma Teams

The concept of treating mass casualties in major disasters, particularly at or near airports, has gained considerable momentum in recent years (1). Major urban airports are almost without exception, plagued by access road traffic problems even under normal circumstances. Given a disaster within the confines of an airport, emergency equipment and medical support are found to be mired in a morass of sightseer and emergency service vehicles, compounding the congestion already present immeasurably (2).Evolving from experiences gained over the past 30 years in handling masses of casualties resulting from aircraft disasters, we at Kennedy Airport have developed a Mobile Emergency Hospital which now serves as the “workshop” for stabilizing large numbers of injuries prior to subsequent transfer to definitive hospitals. The keys to this plan are the Trauma Team support used in conjunction with the mobile hospitals.The ideal trauma team consists of 2 surgeons or trauma-trained physicians, one surgical nurse and one medical or 2 surgical technicians. These teams can be varied according to the immediate situation, time of day, available physicians, nurses and technicians. Anesthesiologists respond either individually or as members of some of the teams reporting directly to the operating units on arrival.For an efficient response plan to function, previous liaison must be established primarily with teaching hospitals with a surgical staff that includes surgery and trauma residents. The Kennedy plan has a working arrangement with the New York Medical College and 8 of its affiliated major teaching hospitals in Manhattan, as well as in the main campus at Valhalla, which maintains an associated Burn Center.

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