Cheryl Ulmer

Cost implications of reduced work hours and workloads for resident physicians.

BACKGROUND Although the Accreditation Council for Graduate Medical Education (ACGME) limits the work hours of residents, concerns about fatigue persist. A new Institute of Medicine (IOM) report recommends, among other changes, improved adherence to the 2003 ACGME limits, naps during extended shifts, a 16-hour limit for shifts without naps, and reduced workloads. METHODS We used published data to estimate labor costs associated with transferring excess work from residents to substitute providers, and we examined the effects of our assumptions in sensitivity analyses. Next, using a probability model to represent labor costs as well as mortality and costs associated with preventable adverse events, we determined the net costs to major teaching hospitals and cost-effectiveness across a range of hypothetical changes in the rate of preventable adverse events. RESULTS Annual labor costs from implementing the IOM recommendations were estimated to be

Future Directions for the National Healthcare Quality and Disparities Reports

1.6 billion (in 2006 U.S. dollars) across all ACGME-accredited programs (

Assessing primary care content: four conditions common in community health center practice.

1.1 billion to

Performance of community health centers under managed care.

2.5 billion in sensitivity analyses). From a 10% decrease to a 10% increase in preventable adverse events, net costs per admission ranged from

Mental Health Services: Critical Component of Integrated Primary Care and Substance Abuse Treatment

99 to

Resident Duty Hours: Enhancing Sleep, Supervision, and Safety.

183 for major teaching hospitals and from

Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement

17 to

Rating Our Progress in Population Health Promotion: Report Card on Six Behaviors

266 for society. With 2.5% to 11.3% decreases in preventable adverse events, costs to society per averted death ranged from

Resident Duty Hours

3.4 million to

COMMITTEE ON OPTIMIZING GRADUATE MEDICAL TRAINEE (RESIDENT) HOURS AND WORK SCHEDULES TO IMPROVE PATIENT SAFETY

0. CONCLUSIONS Implementing the four IOM recommendations would be costly, and their effectiveness is unknown. If highly effective, they could prevent patient harm at reduced or no cost from the societal perspective. However, net costs to teaching hospitals would remain high.