Laine C, Goldman L, Soukup J R, Hayes J G
Department of Medicine, Beth Israel Hospital and Harvard Medical School, Boston, MA.
JAMA. 1993 Jan 20;269(3):374-8.
To examine the impact on patient care of a New York State regulation that restricted house staff working hours.
Retrospective cohort study.
General medical service of an urban teaching hospital.
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.
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.
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.
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.
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.
探讨纽约州一项限制住院医生工作时间的规定对患者护理的影响。
回顾性队列研究。
一家城市教学医院的普通医疗服务部门。
1988年10月从研究科室出院的281名患者中的263名（94%），以及1989年10月从同一科室出院的283名患者中的263名（93%）。
1989年7月1日，纽约州颁布了一项新规定，即第405号法规，该法规限制了住院医生的工作时间，并规定了监督水平和辅助支持。
住院死亡率、转入重症监护病房、心肺复苏尝试、出院处置、住院时间、医疗并发症，以及住院医生在安排检查和治疗程序方面的延误。
尽管两组患者在疾病严重程度指标上具有可比性，但1989年更多患者至少出现了一种医疗并发症（91例[35%]对59例[22%]；P = .002），并且因住院医生原因至少经历了一次诊断检查延误（44例[17%]对4例[2%]；P < .001）。在多变量分析中控制潜在混杂因素后，这些显著差异仍然存在。然而，我们发现更严重的结果（住院死亡率、转入重症监护病房、出院处置或住院时间）没有显著差异。
这些结果表明，住院医生工作时间受限与住院医生安排检查的延误以及住院并发症增加有关。虽然这些对护理质量的潜在有害影响在更严重的结果方面没有导致统计学上的显著差异，但有必要在其他医院进行进一步研究，以确定优化患者护理质量以及住院医生医学教育和生活质量的人员配备策略。
