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New limits on physician training hours could prove costly for US teaching hospitals
Date:9/8/2011

as interns, can work a maximum of 16 hours continuously and must have on-site supervision at all times. More senior residents can work up to 28 consecutive hours when they are "on call" in all but exceptional circumstances. Under previous guidelines, both interns and senior residents could work up to 30 consecutive hours.

Changes in the training environment include educating residents and faculty members about fatigue and patient safety; standardizing the process of giving residents increasing autonomy as they advance through training toward becoming fully qualified physicians; systematizing hand-overs of patient care as one physician comes off duty and another physician comes on; providing transportation or sleep facilities after extended shifts; and establishing annual site visits by the ACGME.

Drawing from published literature and publicly available data sources, the researchers created models to examine the costs of hiring substitutes to perform the work of residents and the potential effects of the changes on rates of harmful medical errors and their associated costs.

They found:

  • The duty-hour changes will cost at least $177 million annually nationwide, based on the most optimistic assumptions about how changes might be implemented. However, under less optimistic assumptions, they could cost up to $982 million annually nationwide.
  • The associated changes to the training environment will cost an additional $204 million annually nationwide.
  • Considering the costs of the reforms and the benefits of reducing harmful medical errors, the reforms are likely to be considered cost-effective to society if medical errors fall by as little as 3 percent a relatively modest decline. However, teaching hospitals would lose money by implementing the reforms unless errors decline to a much greater degree at least 7.2 percent to 25.8 percent, depending on the cost of implementing the duty-hour changes.


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Contact: Enrique Rivero
erivero@mednet.ucla.edu
310-794-2273
University of California - Los Angeles Health Sciences
Source:Eurekalert

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