Mayo Clinic Proceedings Home
MCP Digital Health Home
ORIGINAL ARTICLE| Volume 86, ISSUE 3, P192-196, March 2011

Effect of 16-Hour Duty Periods on Patient Care and Resident Education


      To measure the effect of duty periods no longer than 16 hours on patient care and resident education.


      As part of our Educational Innovations Project, we piloted a novel resident schedule for an inpatient service that eliminated shifts longer than 16 hours without increased staffing or decreased patient admissions on 2 gastroenterology services from August 29 to November 27, 2009. Patient care variables were obtained through medical record review. Resident well-being and educational variables were collected by weekly surveys, end of rotation evaluations, and an electronic card-swipe system.


      Patient care metrics, including 30-day mortality, 30-day readmission rate, and length of stay, were unchanged for the 196 patient care episodes in the 5-week intervention month compared with the 274 episodes in the 8 weeks of control months. However, residents felt less prepared to manage cross-cover of patients (P=.006). There was a nonsignificant trend toward decreased perception of quality of education and balance of personal and professional life during the intervention month. Residents reported working fewer weekly hours overall during the intervention (64.3 vs 68.9 hours; P=.40), but they had significantly more episodes with fewer than 10 hours off between shifts (24 vs 2 episodes; P=.004).


      Inpatient hospital services can be staffed with residents working shifts less than 16 hours without additional residents. However, cross-cover of care, quality of education, and time off between shifts may be adversely affected.
      ACGME (Accreditation Council for Graduate Medical Education), PGY (postgraduate year)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Accreditation Council for Graduate Medical Education (ACGME)
        Resident duty hours.
        (Accessed January 27, 2011.)
        • Landrigan CP
        • Rothschild JM
        • Cronin JW
        • et al.
        Effect of reducing interns' work hours on serious medical errors in intensive care units.
        N Engl J Med. 2004; 351: 1838-1848
        • Tessing S
        • Amendt A
        • Jennings J
        • Thomson J
        • Auger KA
        • Gonzalez del Rey JA
        One possible future for resident hours: interns' perspective on a one-month trial of the Institute of Medicine recommended duty hour limits.
        J Grad Med Educ. 2009; 1: 185-187
        • Ulmer C
        • Miller Wolman D
        • Bruno M
        • Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules to Improve Safety
        • et al.
        Resident Duty Hours: Enhancing Sleep, Supervision, and Safety. National Academies Press, Washington, DC2009: 428
        • Nasca TJ
        • Day SH
        • Amis Jr, ES
        • ACGME Duty Hours Task Force
        The new recommendations on duty hours from the ACGME Task Force.
        N Engl J Med. 2010; 363: e3
        • Lockley SW
        • Cronin JW
        • Evans EE
        • et al.
        Effect of reducing interns' weekly work hours on sleep and attentional failures.
        N Engl J Med. 2004; 351: 1829-1837
        • Accreditation Council for Graduate Medical Education (ACGME)
        Educational Innovations Project.
        (Accessed January 27, 2011.)
        • Vidyarthi AR
        • Arora V
        • Schnipper JL
        • Wall SD
        • Wachter RM
        Managing discontinuity in academic medical centers: strategies for a safe and effective resident sign-out.
        J Hosp Med. 2006; 1: 257-266
        • Johns MW
        A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale.
        Sleep. 1991; 14: 540-545
        • Bhavsar J
        • Montgomery D
        • Li J
        • et al.
        Impact of duty hours restrictions on quality of care and clinical outcomes.
        Am J Med. 2007; 120: 968-974
        • Volpp KG
        • Rosen AK
        • Rosenbaum PR
        • et al.
        Mortality among patients in VA Hospitals in the first 2 years following ACGME resident duty hour reform.
        JAMA. 2007; 298: 984-992
        • Vidyarthi AR
        • Katz PP
        • Wall SD
        • Wachter RM
        • Auerbach AD
        Impact of reduced duty hours on residents' educational satisfaction at the University of California, San Francisco.
        Acad Med. 2006; 81: 76-81
        • Accreditation Council for Graduate Medical Education
        Program requirements for residency education in internal medicine.
        (Accessed January 27, 2011.)

      Linked Article

      • Duty Hours: Where Do We Go From Here?
        Mayo Clinic ProceedingsVol. 86Issue 3
        • Preview
          In this issue of Mayo Clinic Proceedings, 2 articles explore the effects that limiting resident physician duty hours have had on the learning environment and patient care.1,2 These articles will prompt discussion among resident physicians and their faculty and evoke memories for those of us who completed residency training in an earlier era. In this regard, I am no exception.
        • Full-Text
        • PDF
      • The Times, They Are A-Changing: Maybe We Need To Change Too
        Mayo Clinic ProceedingsVol. 86Issue 3
        • Preview
          In this issue of Mayo Clinic Proceedings, 2 articles from Mayo Clinic investigators1,2 have provided important analyses of the effects of the upcoming Accreditation Council for Graduate Medical Education (ACGME) duty hour recommendations.3 The article by Antiel et al1 is based on a survey of residency program directors (medicine, pediatric, surgery) and reports the program directors' expectations of the effect the new ACGME recommendations will have on the ability of residents to achieve competency in several core areas.
        • Full-Text
        • PDF