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Shifting patients: how residency programs respond to residency review committee requirements

2003; Elsevier BV; Volume: 115; Issue: 2 Linguagem: Inglês

10.1016/s0002-9343(03)00332-2

1555-7162

Julie A Morelock, David Stern,

Emergency and Acute Care Studies

Resident physicians are confronted by the competing demands of service, learning, quality of life, and patient safety. Under the demands of service, hospitals are admitting more patients with decreasing length of stay and increasing acuity of care ( 1 Every N.R. Spertus J. Fihn S.D. Hlatky M. Martin J.S. Weaver W.D. Length of hospital stay after acute myocardial infarction in the Myocardial Triage and Intervention (MITI) Project registry. J Am Coll Cardiol. 1996; 28: 287-293 Abstract Full Text PDF PubMed Google Scholar , 2 Rosenberg A.L. Zimmerman J.E. Alzola C. Draper E.A. Knaus W.A. Intensive care unit length of stay recent changes and future challenges. Crit Care Med. 2000; 8: 3465-3473 Crossref Scopus (58) Google Scholar , 3 Weinstein J.W. Mazon D. Pantelick E. Reagan-Cirincione P. Dembry L.M. Hierholzer Jr, W.J. A decade of prevalence surveys in a tertiary-care center trends in nosocomial infection rates, device utilization, and patient acuity. Infect Control Hosp Epidemiol. 1999; 20: 543-548 Crossref PubMed Scopus (107) Google Scholar ). At the University of Michigan Hospitals, the internal medicine service admitted 7703 patients in fiscal year 1989–1990 with an average stay of 8.7 days compared with 11,331 patients for an average stay of 5.5 days in 1999–2000. Nationally, similar statistics have been noted ( 4 HCUPnet, Healthcare Cost and Utilization Project. Agency for Healthcare Research and Quality, Rockville, MD. Available at: http://www.ahrq.gov/data/hcup/hcupnet.htm. Accessed May 30, 2003 Google Scholar ). With fixed or decreasing hospital revenues, the pressure to care for an increased volume of patients has often increased the workload of the remaining residents ( 5 Mangan K.S. Cutting back to an 80-hour week. Chron High Educ. 2000; 47: A43-A44 Google Scholar ). In conflict with the demands of service are the demands for learning and quality of life, as defined, in part, by the American College of Graduate Medical Education (ACGME) Residency Review Committees in their regulation of workload. In response to mismanagement attributed to resident fatigue and error ( 6 Gaba D.M. Howard S.K. Fatigue among clinicians and the safety of patients. N Eng J Med. 2002; 347: 1249-1255 Crossref PubMed Scopus (538) Google Scholar , 7 Steinbrook R. The debate over residents’ work hours. N Engl Med. 2002; 347: 1296-1302 Crossref PubMed Scopus (160) Google Scholar ), state and federal legislation has focused on a reduction in residents’ work hours.