Balancing Continuity of Care with Residents' Limited Work Hours

Defining the Implications

The Accreditation Council for Graduate Medical Education (ACGME) revised the duty-hour requirements for residency programs in July 2003. This study presented a model for evaluating the effect of the new requirements on continuity of inpatient care.

Key Findings:

  • Continuity should be viewed from patient, physician and health care system perspectives.
  • There are benefits and drawbacks to continuity of inpatient care. Benefits include the relationship patients may develop with physicians while drawbacks can be compromised patient care or physician (particularly resident) fatigue.
  • Many of the outcomes studied in regard to continuity of inpatient care focus on residents, for example, how residents perform in their roles and resident health. Fewer studies have measured patient outcomes or explored non-resident or non-patient components of the health care system.
  • Solutions for resident issues, such as fatigue, in continuity of care have involved float and shift-work systems. There are benefits and harms to each solution whether they are measured or not and are intended or unintended.
  • Those in the medical field need to plan and put into place outcome assessments of the new ACGME requirements. The framework presented in this article should be helpful in that regard.

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