Second, patient care is helped along when staff are able to reduce the number of hand-offs and transitions of care. Limiting one member of a team to an hours limit to which others don’t have to adhere to opens the door to a problem in transferring information. “If you were to have frequent handovers, there’s potential for error,” Dr. Vasan added. “That’s why companies now exist that utilize software as a means to minimize errors and to make sure that everyone’s on the same page. This is something new that has been created because of work-hour restrictions.”
Dr. Zetterman said there is one major study that looked at hours limits and their impact on patient outcomes. The review, which was published in The New England Journal of Medicine in February 2016 and involved 117 U.S. general surgery residency programs and 151 hospitals, found that longer shifts and less time off between shifts were not associated with an increased rate of death or serious complications (9.1% in the flexible-policy group and 9.0% in the standard-policy group) or of any secondary postoperative outcomes studied (N Engl J Med. 2016;374:713-727). “That was certainly an added factor,” Dr. Zetterman said.
The third leg of the proverbial stool that is continuity of care is the health of physicians themselves, Dr. Vasan said. To wit, the NEJM surgical study found “no significant difference in residents’ satisfaction with overall well-being and education quality.”