Research Activities, November-December 2013
Having surgical interns on call from home rather than at the hospital does not increase postoperative complications
Patient Safety and Quality
Postoperative complications are not increased when surgical interns are on call from home rather than at the hospital, concludes a new study. It found no rise in overall postoperative morbidity or mortality rates between 1999–2003, when interns had to be on call at the hospital, and 2004–2010, when they could be on call from home. These findings are important, because the Accreditation Council for Graduate Medical Education (ACGME) forbade surgical intern home calls as of July 2011 as part of its new guidelines on resident work hours.
The researchers conducted the study at a single Veterans Affairs (VA) Medical Center to test the impact of the intern home call schedule. During 1999–2003, the first call for all patients went to an in-hospital surgical intern; during 2004–2010, the first call went to an intern on call from home.
The new ACGME work-hour restrictions assume that having surgical interns on call from home, outside of standard working hours, would be associated with increased postoperative morbidity and mortality rates. Instead, the researchers found a significant decrease in unadjusted overall morbidity rates from the 1999–2003 to the 2004–2010 period (from 12.14 percent to 10.19 percent). When they looked at the ratio of observed-to-expected risk-adjusted morbidity in these two time periods, a uniform annual percentage decrease of 6.03 percent was observed. The unadjusted overall mortality rates also declined between the hospital on-call and home on-call periods (from 1.76 percent to 1.26 percent), but no significant change was found in the risk-adjusted mortality ratios.
The findings were based on data from the VA National Surgical Quality Improvement Program—including all patients whose surgery was performed by the general, vascular, urologic, or cardiac surgery services. The study was funded in part by AHRQ (T32 HS00028).
More details are in "The influence of intern home call on objectively measured perioperative outcomes," by Zachary J. Kastenberg, M.D., Kim F. Rhoads, M.D., M.S., M.P.H., Marc L. Melcher, M.D., Ph.D., and others in the April 2013 Journal of the American Medical Association–Surgery 148(4), pp. 347-351.