UCSF

Study objective

To determine whether adaptations to comply with Accreditation Council for Graduate Medical Education (ACGME) duty hour requirements are associated with changes in total cost and length of stay.

Design

Retrospective, interrupted time-series cohort study using concurrent control patients.

Setting

UCSF Benioff Children's Hospital, San Francisco, CA.

Patients

Inpatients newborn to 18 y on the primary pediatrics medical-surgical unit. Medical patients were studied before and after an intervention, and surgical patients served as a concurrent control group.

Intervention

Pediatrics trainees' work schedules were changed from those that relied on prolonged call shifts to those primarily based on shorter day shifts and night shifts.

Results

We detected significant relative reductions in length of stay but not in total cost. When the analysis was limited to the subset of patients who did not receive intensive care unit care, length of stay decreased by 18% and total cost decreased by 10%. We did not detect similar changes in the control group.

Conclusions

A trainee staffing model that included shorter shifts as consistent with current ACGME duty hour requirements was associated with reduced length of stay and total costs for patients not in the intensive care unit.