Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California.
J Surg Educ. 2016 Jan-Feb;73(1):173-9. doi: 10.1016/j.jsurg.2015.07.016. Epub 2015 Aug 28.
The effect of resident duty hour restrictions continues to yield conflicting results on patient outcomes. Failure to rescue (FTR), or death after a major complication, has become a topic of increasing quality assessment. The aim of this study is to evaluate the effect of duty hour restrictions on in-hospital mortality, complication rates, and FTR in patients suffering traumatic injuries.
Data from the National Trauma Data Bank (NTDB) were retrospectively reviewed (Research Data Set 2007-2008 and version 7.2). Patients admitted to Level I or II teaching institutions were dichotomized into pre-duty hour restriction (2002-2003) and post-duty hour restriction (2007-2008) time periods. Patients who had nonsurvivable injuries (any region Abbreviated Injury Scale score = 6), died within 48 hours, or had missing data were excluded. Multivariate logistic regression was used to adjust for differences in patient characteristics and derive adjusted outcomes.
Level I and II teaching institutions in the NTDB.
All patients with trauma admitted to a Level I or II teaching institution between January 1, 2002 and June 30, 2003 and between January 1, 2007 and December 31, 2008.
Although overall adjusted in-hospital mortality was decreased (adjusted odds ratio [AOR] = 0.7, p < 0.001) in the post-duty hour restriction era, overall complications (AOR = 2.0, p < 0.001) and FTR (AOR = 2.0, p < 0.001) were significantly higher.
Although there may be some benefit to resident duty hour restrictions, there is still room for improvement in patient care. Individual institutions should carefully review their own complication data to identify preventable systems issues, such as poor handoffs, and opportunities for increased resident supervision.
住院医师工作时间限制对患者结局的影响仍存在争议。救治失败（failure to rescue，FTR），即患者发生重大并发症后死亡，已成为质量评估日益关注的话题。本研究旨在评估工作时间限制对创伤患者院内死亡率、并发症发生率和 FTR 的影响。
回顾性分析国家创伤数据库（National Trauma Data Bank，NTDB）的数据（研究数据集 2007-2008 年和版本 7.2）。将收入一级或二级教学医院的患者分为工作时间限制前（2002-2003 年）和工作时间限制后（2007-2008 年）两个时间段。排除不可存活损伤（任何部位损伤严重度评分 Abbreviated Injury Scale 评分=6）、48 小时内死亡或数据缺失的患者。采用多变量逻辑回归调整患者特征差异，得出调整后的结局。
NTDB 中的一级和二级教学医院。
2002 年 1 月 1 日至 2003 年 6 月 30 日和 2007 年 1 月 1 日至 2008 年 12 月 31 日期间收入一级或二级教学医院的所有创伤患者。
虽然工作时间限制后总体调整后的院内死亡率降低（调整后的优势比[adjusted odds ratio，AOR] = 0.7，p<0.001），但总体并发症（AOR = 2.0，p<0.001）和 FTR（AOR = 2.0，p<0.001）明显升高。
尽管住院医师工作时间限制可能带来一定益处，但患者的护理仍有改进空间。个别机构应仔细审查自身的并发症数据，以确定可预防的系统问题，如交接班不良和增加住院医师监督的机会。
