Ponor, Lucia

ABSTRACT Background The Accreditation Council for Graduate Medical Education (ACGME) has mandated revisions to residents' work hours to improve patient safety and enhance resident education and wellness. The impact on clinical outcomes on a national level is poorly understood. Objective We examined data from before and after the ACGME 2011 duty hour revision and looked for differences between teaching and nonteaching US hospitals. Methods A retrospective observational study of patients admitted to hospitals in the 2-year periods before and after the 2011 duty hour revision was conducted, utilizing a nationally representative data set. We compared patient and hospital characteristics using standardized differences. With nonteaching hospitals serving as the control group, we used multiple group interrupted time series segmented regression analysis to test for postrevision level and trend changes in mortality, length of stay (LOS), and costs. Results We examined more than 117 million hospitalizations. At teaching and nonteaching hospitals, trends in mortality and LOS in prerevision and postrevision periods were not significantly different (all P > .05). A significant monthly reduction in cost per hospitalization was noted postrevision at teaching hospitals (P = .019) but not at nonteaching hospitals (P = .62). In the 2 years following the 2011 revision, there was a monthly reduction in cost per hospitalization (–$52.28; 95% confidence interval –$116.90 to –$12.32; P = .026) at teaching relative to nonteaching hospitals. Conclusions There were no differences in mortality or LOS between teaching and nonteaching hospitals. However, there was a small decrease in cost per hospitalization at teaching hospitals following the 2011 revision.

BACKGROUNDThere is a glaring lack of published evidence‐based strategies to improve the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient experience scores on the physician domain. Strategies that have been used are resource intensive and difficult to sustain.OBJECTIVEWe hypothesized that prompting providers to assess their own etiquette‐based practices every 2 weeks over the course of 1 year would improve patient experience on the physician domain.DESIGNRandomized controlled trial.SETTING4 acute care hospitals.PARTICIPANTSHospitalists.INTERVENTIONHospitalists were randomized to the study or the control arm. The study arm was prompted every 2 weeks for 12 months to report how frequently they engaged in 7 best‐practice bedside etiquette behaviors. Control arm participants received similarly worded questions on quality improvement behaviors.MEASUREMENTProvider experience scores were calculated from the physician HCAHPS and Press Ganey survey provider items.RESULTSPhysicians reported high rates of etiquette‐based behavior at baseline, and this changed modestly over the study period. Self‐reported etiquette behaviors were not associated with experience scores. The difference in difference analysis of the baseline and postintervention physician experience scores between the intervention arm and the control arm was not statistically significant (P = 0.71).CONCLUSIONIn this 12‐month study, biweekly reflection and reporting of best‐practice bedside etiquette behaviors did not result in significant improvement on physician domain experience scores. It is likely that hospitalists' self‐assessment of their bedside etiquette may not reflect patient perception of these behaviors. Furthermore, hospitalists may be resistant to improvement in this area since they rate themselves highly at baseline.