The impact of the resident duty hour regulations on surgical patients’ perceptions of care

Implementation of the 2003 Accreditation Council for Graduate Medical Education (ACGME) resident duty-hour regulations and access to publicly reported patient satisfaction measures have challenged administrators and clinicians to balance resident’s educational experience, patient care quality, and patients’ satisfaction and perceptions. A pre-post retrospective study design investigated association between implementation of ACGME regulations and patient satisfaction/perceptions using multinomial logistic regressions. The sample consisted of all surgical inpatients (July 2001 – June 2005), who responded to surveys at an academic medical center. Patients gave lower ratings for physician interactions (patient-physician interaction time, clinical updates, and courtesy) following the implementation of post-duty hour regulations. While the odds of patients rating “below good” post-implementation for physician survey questions (i.e., related to time spent, kept informed, and friendliness/ courtesy) were higher (i.e., 1.25 to 1.3) as compared to odds of rating “very good”, the overall rating of quality care improved post-implementation. This difference could be due to increased interaction of patients with other hospital personnel. To improve patient satisfactions and in turn their perceptions, initiatives such as workload balancing, hand-off protocols, patient communication, and interactive training for care providers are recommended. Finally, residency programs and institutions need to develop strategies for implementation of current and future ACGME duty hour regulations so as to balance patient safety, patient perceptions, and resident well-being