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The Effect of House Staff Working Hours on the Quality of Obstetric and Gynecologic Care

Jennifer L. Bailit, MD, MPH^* and May Hsieh Blanchard, MD

From the *Division of Maternal–Fetal Medicine and the Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.

OBJECTIVE: To measure the effect of house staff working hours reforms on the quality of obstetric and gynecologic care.

METHODS: Sentinel events, medication errors, maternal and neonatal outcomes, and decision making were measured before and after the Accreditation Council of Graduate Medical Education work-hour reforms. Data sources consisted of the perinatal database at MetroHealth Medical Center (Case Western Reserve University, Cleveland, OH), incident reports filed in the hospital department of risk management, the patient-satisfaction database at MetroHealth Medical Center, and the pharmacy medication error database. Two reviewers examined all incident reports separately, and discrepancies were resolved by mutual agreement.

RESULTS: Patient demographics did not change across the 2 time periods. Obstetric outcomes were the same for third- and fourth-degree lacerations, umbilical arterial pH less than 7, fever, and the need for general anesthesia. Postpartum hemorrhage and neonatal resuscitations were significantly decreased over time (2% before versus 1% after work-hour restrictions [P = .008], and 30% before versus 26% after work-hour restrictions [P < .001], respectively). The rate of primary cesarean delivery rose from 14% to 16%, a nonsignificant difference (P < .06). There were no differences in rates of cesarean delivery for nonreassuring fetal status, failed induction, labor abnormality, or repeat cesarean delivery. Reported medication errors associated with resident performance were too rare for comparison across time periods. The number of incident reports directly involving residents before and after work-hour restrictions were 3 and 10, respectively—too few to reach statistical significance.

CONCLUSIONS: Although problems in physician performance may be underreported, resident work-hour restrictions show minimal evidence of improvement in quality of care.

LEVEL OF EVIDENCE: II-3

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