Flexible Schedules for Residents Do Not Affect Patient Mortality

A schedule of flexible duty hours within the 80-hour constraints is noninferior to standard work hours for the effects on 30-day patient mortality and average duration of sleep for residents, according to two studies published in the March 7 issue of the New England Journal of Medicine.

Jeffrey H. Silber, M.D., Ph.D., from the Children's Hospital of Philadelphia, and colleagues conducted a noninferiority randomized trial involving 63 internal medicine residency programs. Programs were randomly assigned to either a group with 2011 standard work hours or a group with flexible duty-hour rules. The researchers found that the change in 30-day mortality was noninferior among patients in the flexible programs (12.5 percent in the trial year versus 12.6 percent in the pretrial year) versus the standard programs (12.2 versus 12.7 percent). The test for noninferiority was significant (P = 0.03).

Mathias Basner, M.D., Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues randomly assigned 63 internal medicine residency programs to follow standard 2011 duty-hour policies or flexible policies that maintained an 80-hour workweek. Data were obtained for 205 interns at six flexible programs and 193 interns at six standard programs during a 14-day period. The researchers found that average sleep time was 6.85 and 7.03 hours among those in flexible and standard programs, respectively. Compared with standard programs, sleep duration was noninferior in flexible programs (P = 0.02 for noninferiority).

"We can confidently say that working flexible hours, still within the 80-hour constraints, does not result in higher patient mortality than working standard hours," write the authors of an accompanying editorial. "We also now know that interns do not sleep significantly more or less when following either of these schedules."

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