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Christine Laine, MD, MPH; Lee Goldman, MD, MPH; Jane R. Soukup, MS; Joseph G. Hayes, MD

JAMA. 1993;269(3):374-378.

Abstract
Objective.
—To examine the impact on patient care of a New York State regulation that restricted house staff working hours.

Design.
—Retrospective cohort study.

Setting.
—General medical service of an urban teaching hospital.

Patients.
—A total of 263 (94%) of 281 patients discharged from the study service during October 1988 and 263 (93%) of 283 patients discharged from the same service during October 1989.

Interventions.
—On July 1, 1989, New York State enacted a new regulation, Code 405, which limited residents' working hours and specified levels of supervision and ancillary support.

Main Outcome Measures.
—In-hospital mortality, transfers to intensive care units, cardiopulmonary resuscitation attempts, discharge disposition, length of stay, medical complications, and house staff delays in ordering tests and procedures.

Results.
—Although the cohorts were comparable in severity of illness measures, more patients in 1989 suffered at least one medical complication (91 [35%] vs 59 [22%];P=.002) and experienced at least one diagnostic test delay because of house staff (44 [17%] vs 4 [2%];P<.001). These significant differences persisted after controlling for potential confounders in multivariate analyses. However, we found no significant differences in more serious outcomes: in-hospital mortality, transfer to intensive care unit, discharge disposition, or length of stay.

Conclusions.
—These results suggest that restricted house staff working hours were associated with delayed test ordering by house staff and increased in-hospital complications. While these potentially deleterious effects on the quality of care did not result in statistically significant differences in more serious outcomes, further study at other hospitals is warranted to determine staffing strategies that optimize quality of care for patients, as well as medical education and quality of life for house officers

(JAMA. 1993;269:374-378)

Author Affiliations
From the Division of General Medicine and the Division of Clinical Epidemiology, Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston, Mass (Drs Laine, Goldman, and Soukup), and the Department of Medicine, The New York Hospital, Cornell University Medical College, New York, NY (Dr Hayes). Dr Laine is now with the Division of Internal Medicine and the Center for Research in Medical Education and Health Care, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pa.

Footnotes
Presented in abstract form at the annual meeting of the Society of General Internal Medicine, Seattle, Wash, May 1-4, 1991.

Reprint requests to Center for Research in Medical Education and Health Care, Jefferson Medical College, 1025 Walnut St, Philadelphia, PA 19107 (Dr Laine).

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