Teryl K. Nuckols

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

The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

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

Rates and types of events reported to established incident reporting systems in two US hospitals

1.1 billion to

Programmable Infusion Pumps in ICUs: An Analysis of Corresponding Adverse Drug Events

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

Residency work-hours reform

99 to

Rigorous Development does not Ensure that Guidelines are Acceptable to a Panel of Knowledgeable Providers

183 for major teaching hospitals and from

Costs of Intravenous Adverse Drug Events in Academic and Nonacademic Intensive Care Units

17 to

Cost Implications of ACGME’s 2011 Changes to Resident Duty Hours and the Training Environment

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

Contributing factors identified by hospital incident report narratives

3.4 million to

Surgery for Degenerative Lumbar Scoliosis: The Development of Appropriateness Criteria.

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.