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Am J Perinatol 2018; 35(09): 911-918
DOI: 10.1055/s-0038-1627442
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Association of Resident Duty Hour Restrictions, Level of Trainee, and Number of Available Residents with Mortality in the Neonatal Intensive Care Unit

Marc Beltempo   *
1   Department of Neonatology, Montreal Children's Hospital, Montréal, Québec, Canada
,
Karin Clement   *
2   Department of Pediatrics, CHU de Québec, Québec, Canada
,
Guy Lacroix
3   Department of Economics, Université Laval, Quebec, Canada
,
Sylvie Bélanger
4   Department of Neonatology, Université Laval, Québec, Canada
,
Anne-Sophie Julien
5   Department of Statistics, CHU de Québec Research Center, Québec, Canada
,
Bruno Piedboeuf
6   Department of Neonatology, Faculté de Médecine, Université Laval, Quebec, Canada
› Author Affiliations Funding This study was supported by a grant from the Fédération des Médecins Résidents du Québec, Canada.
Further Information

Publication History

20 May 2017

04 January 2018

Publication Date:
08 February 2018 (online)

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Abstract

Objective This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU.

Study Design This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU (N = 185) and infants admitted to the NICU (N = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008–2011 [24-hour shifts] versus 2011–2014 [16-hour shifts]), level of trainee, and the number of residents present at admission.

Results The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, p < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33–0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71–2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43–10.02, 5–8 residents vs. 0–2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50–1.07; after vs. before resident duty hour reform).

Conclusion Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates.

Keywords

infant - premature - workforce - resident education/training - morbidity/mortality

* Marc Beltempo and Karin Clement are co-primary authors.


Supplementary Material

 

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