Association between Adaptations to ACGME Duty Hour Requirements, Length of Stay, and Costs

作者：Rosenbluth Glenn^*; Fiore Darren M; Maselli Judith H; Vittinghoff Eric; Wilson Stephen D; Auerbach Andrew D

来源：Sleep, 2013, 36(2): 245-248.

DOI：10.5665/sleep.2382

• Cost of hospitalization
• duty hour
• length of stay
• shift work
• trainees

Study Objective: To determine whether adaptations to comply with Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements are associated with changes in total cost and length of stay.
Design: Retrospective, interrupted time-series cohort study using concurrent control patients.
Setting: UCSF Benioff Children's Hospital, San Francisco, CA.
Patients: Inpatients newborn to 18 y on the primary pediatrics medical-surgical unit. Medical patients were studied before and after an intervention, and surgical patients served as a concurrent control group.
Intervention: Pediatrics trainees' work schedules were changed from those that relied on prolonged call shifts to those primarily based on shorter day shifts and night shifts.
Results: We detected significant relative reductions in length of stay but not in total cost. When the analysis was limited to the subset of patients who did not receive intensive care unit care, length of stay decreased by 18% and total cost decreased by 10%. We did not detect similar changes in the control group.
Conclusions: A trainee staffing model that included shorter shifts as consistent with current ACGME duty hour requirements was associated with reduced length of stay and total costs for patients not in the intensive care unit.

• 出版日期2013-2-1