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Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study
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Impact of Resident Overnight Duty Hour Changes on Obstetrical Outcomes: A Population-Based Cohort Study
B. Liu MD FRCSC1, M. Ordon MD MSc FRCSC2, J. Bodley MD MSc FRCSC1, G. Liu MD MSc FRCSC1, J. Kroft MD MSc FRCSC1 1 - Department of Obstetrics & Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, CANADA 2 – Department of Surgery, Division of Urology, St. Michael’s Hospital, University of Toronto, ON, CANADA


INTRODUCTION: Sleep deprivation has been shown to have effects on mood, cognition, and psychomotor function, and can have similar effects to alcohol consumption [1-3]. Many residency programs around the world are now implementing work hour restrictions [4]. The effects of this new system on patient outcomes is unclear [4-5]. The Obstetrics program at the University of Toronto has recently adopted a “night float” system, in which residents work for a restricted number of hours overnight but work for four consecutive nights in a row. The objective of this study was to determine if there has been a change in patient outcomes since the implementation of the new system of restricted resident work hours.


METHODS: We performed a population-based, retrospective cohort study using linked healthcare administrative databases in the province of Ontario, Canada. We included all obstetrical patients who underwent a delivery between July 2011 and June 2015 (two years prior to and after the implementation of resident duty hour restrictions), at three academic hospitals in Toronto, Canada.
The primary outcome was a composite index of numerous maternal/fetal outcomes including maternal transfusion/postpartum hemorrhage (PPH), maternal infection, fetal mortality, NICU admissions and surgical/obstetrical complications. Secondary outcomes included assessment of each of the components of the primary outcome examined separately.


RESULTS: There were no significant differences between groups for any of the baseline characteristics (see Table 1). There was no significant difference found in the primary outcome (Table 2). After the implementation of the night float system, an increased incidence of composite maternal surgical/obstetrical outcomes and transfusion/postpartum hemorrhage was found (Table 3). There was no significant difference in the other secondary outcomes.


CONCLUSION: Since the implementation of reduced duty hour restrictions at the University of Toronto Obstetrics and Gynecology program, there has been an increased incidence of surgical/obstetrical maternal complications and transfusion/postpartum hemorrhage at the three academic hospitals. Although this is an observational study and we cannot infer causation, it certainly highlights the need to further investigate the clinical impact a change in resident duty hours has, in order to determine the best strategy to adopt moving forward.



REFERENCES: 1. Olson E, Drage L, Auger R. Sleep deprivation, physician performance, and patient safety. Chest 2009;136:1389-96. 2. Phillbert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep. 2005(28):1392-402. 3. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature. 1997;388:235 4. Ahmed, N. et al. (2014). A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg, 259(6), 1041-1053. 5. Jamal M, Wong S, Whalen T. Effects of the reduction of surgical residents' work hours and implications for surgical residency programs: a narrative review. BMC Medical Education. 2014;14(Suppl 1):S14.

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