Prolonged hospital stay and the resident duty hour rules of 2003

Jeffrey H. Silber, Paul R. Rosenbaum, Amy K. Rosen, Patrick S Romano, Kamal M F Itani, Liyi Cen, Lanyu Mi, Michael J. Halenar, Orit Even-Shoshan, Kevin G. Volpp

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


BACKGROUND: Resident duty hour reforms of 2003 had the potential to create a major impact on the delivery of inpatient care. OBJECTIVE: We examine whether the reforms influenced the probability of a patient experiencing a prolonged hospital length of stay (PLOS), a measure reflecting either inefficiency of care or the development of complications that may slow the rate of discharge. RESEARCH DESIGN: Conditional logistic models to compare PLOS in more versus less teaching-intensive hospitals before and after the reform, adjusting for patient comorbidities, common time trends, and hospital site. SUBJECTS: Medicare (N = 6,059,015) and Veterans Affairs (VA) (N = 210,276) patients admitted for medical conditions (acute myocardial infarction, heart failure, stroke, or gastrointestinal bleeding) or surgical procedures (general, orthopedic, and vascular) from July 2000 to June 2005. MEASURES: Prolonged length of stay. RESULTS: Modeling all medical conditions together, the odds of prolonged stay in the first year post reform at more versus less teaching intensive hospitals was 1.01 (95% CI: 0.97-1.05) for Medicare and 1.07 (0.94-1.20) for the VA. Results were similarly negative in the second year post reform. For "combined surgery" the post year 1 odds ratios were 1.04 (0.98-1.09) and 0.94 (0.78-1.14) for Medicare and the VA respectively, and similarly unchanged in post year 2. Isolated increases in the probability of prolonged stay did occur for some vascular surgery procedures. CONCLUSIONS: Hospitals generally found ways to cope with duty hour reform without increasing the prevalence of prolonged hospital stays, a marker of either inefficient care or complications.

Original languageEnglish (US)
Pages (from-to)1191-1200
Number of pages10
JournalMedical Care
Issue number12
StatePublished - Dec 2009


  • Difference-in-differences
  • Prolonged length of stay
  • Teaching hospitals

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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