User login
Resident physician work-hour regulations associated with improved physician safety and health
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) enacted a consecutive work-hour restriction of 16 hours for first-year residents. Reports of these changes have focused on patient safety, resident education, and resident well-being. The impact on resident safety had not been addressed.
Study design: Prospective cohort study.
Setting: U.S. Academic institutions training resident physicians.
Synopsis: This study compared first-year resident physicians from 2002 to 2007 (pre-implementation) and 2014 to 2017 (post-implementation). In all, 5,680 pre-implementation residents and 9,596 post-implementation residents consented to the study. With the 2011 ACGME restriction, the risk of motor vehicle crash decreased 24% (relative risk [RR] .76; .67-.85), and percutaneous injury risk decreased more than 40% (RR .54; .48-.61). Although weekly work hours were significantly higher pre-implementation, self-reported hours involved in patient care were similar for both groups.
While this large, well-powered study suggests extended work-hour restrictions for resident physicians improve their safety, the study is limited by self-reporting of resident physicians. As the ACGME has re-introduced extended duration shifts for first-year resident physicians, hospitalists should advocate for objective physician safety studies in relation to extended-hour shifts.
Bottom line: The 2011 ACGME work-hour reform for first-year physicians improved their safety and health.
Citation: Weaver MD et al. The association between resident physician work-hour regulations and physician safety and health. Am J Med. 2020 July;133(7):e343-54.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Autopsy findings reveal venous thromboembolism in patients with COVID-19
Background: Despite the increased mortality rate of the novel coronavirus compared with influenza, little is understood about its pathogenicity. Prior studies have identified D-dimer levels, high Sequential Organ Failure Assessment score, and older age as markers for more severe disease and mortality. The specific cause of death of COVID-19 remains largely unknown.
Study design: Prospective cohort study.
Setting: Single academic center in Germany.
Synopsis: A complete autopsy was performed on 12 consecutive COVID-19 patient deaths at a single center. Seven had evidence of venous thromboembolism (VTE): three with bilateral lower extremity deep venous thrombosis (DVT) and four with massive pulmonary embolism/associated lower-extremity DVT. Prior to death, VTE was suspected clinically in only a single patient.
This small case series piques interest in the potential underrecognized thromboembolic pathology of COVID-19. While not practice changing, this study highlights the importance of hospitalists staying attuned to further studies regarding VTE prophylaxis in COVID-19.
Bottom line: Autopsies of COVID-19 patients revealed a high incidence of thromboembolic events; COVID-19–induced coagulopathy may play an underrecognized role in pathogenesis.
Citation: Wichmann D et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(4):268-77.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: Despite the increased mortality rate of the novel coronavirus compared with influenza, little is understood about its pathogenicity. Prior studies have identified D-dimer levels, high Sequential Organ Failure Assessment score, and older age as markers for more severe disease and mortality. The specific cause of death of COVID-19 remains largely unknown.
Study design: Prospective cohort study.
Setting: Single academic center in Germany.
Synopsis: A complete autopsy was performed on 12 consecutive COVID-19 patient deaths at a single center. Seven had evidence of venous thromboembolism (VTE): three with bilateral lower extremity deep venous thrombosis (DVT) and four with massive pulmonary embolism/associated lower-extremity DVT. Prior to death, VTE was suspected clinically in only a single patient.
This small case series piques interest in the potential underrecognized thromboembolic pathology of COVID-19. While not practice changing, this study highlights the importance of hospitalists staying attuned to further studies regarding VTE prophylaxis in COVID-19.
Bottom line: Autopsies of COVID-19 patients revealed a high incidence of thromboembolic events; COVID-19–induced coagulopathy may play an underrecognized role in pathogenesis.
Citation: Wichmann D et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(4):268-77.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.
Background: Despite the increased mortality rate of the novel coronavirus compared with influenza, little is understood about its pathogenicity. Prior studies have identified D-dimer levels, high Sequential Organ Failure Assessment score, and older age as markers for more severe disease and mortality. The specific cause of death of COVID-19 remains largely unknown.
Study design: Prospective cohort study.
Setting: Single academic center in Germany.
Synopsis: A complete autopsy was performed on 12 consecutive COVID-19 patient deaths at a single center. Seven had evidence of venous thromboembolism (VTE): three with bilateral lower extremity deep venous thrombosis (DVT) and four with massive pulmonary embolism/associated lower-extremity DVT. Prior to death, VTE was suspected clinically in only a single patient.
This small case series piques interest in the potential underrecognized thromboembolic pathology of COVID-19. While not practice changing, this study highlights the importance of hospitalists staying attuned to further studies regarding VTE prophylaxis in COVID-19.
Bottom line: Autopsies of COVID-19 patients revealed a high incidence of thromboembolic events; COVID-19–induced coagulopathy may play an underrecognized role in pathogenesis.
Citation: Wichmann D et al. Autopsy findings and venous thromboembolism in patients with COVID-19. Ann Intern Med. 2020;173(4):268-77.
Dr. Fletcher is a hospitalist at the Lexington (Ky.) VA Health Care System.