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Original Article
April 2013

The Influence of Intern Home Call on Objectively Measured Perioperative Outcomes

Author Affiliations

Author Affiliations: Department of Surgery, Stanford University School of Medicine (Drs Kastenberg, Rhoads, Melcher, and Wren) and Palo Alto Veterans Health Care System (Dr Wren), Palo Alto, California.

JAMA Surg. 2013;148(4):347-351. doi:10.1001/jamasurg.2013.1063
Abstract

Hypothesis In July 2011, surgical interns were prohibited from being on call from home by the new residency review committee guidelines on work hours. In support of the new Accreditation Council for Graduate Medical Education work-hour restrictions, we expected that a period of intern home call would correlate with increased rates of postoperative morbidity and mortality.

Design Prospective cohort.

Setting University-affiliated tertiary Veterans Affairs Medical Center.

Patients All patients identified in the Veterans Affairs National Surgical Quality Improvement Program database who underwent an operation performed by general, vascular, urologic, or cardiac surgery services between fiscal years (FYs) 1999 and 2010 were included.

Main Outcome Measures During FYs 1999-2003, the first call for all patients went to an in-hospital intern. In the subsequent period (FYs 2004-2010), the first call went to an intern on home call. Thirty-day unadjusted morbidity and mortality rates and risk-adjusted observed to expected ratios were analyzed by univariate analysis and joinpoint regression, respectively.

Results Unadjusted overall morbidity rates decreased between 1999-2003 and 2004-2010 (12.14% to 10.19%, =  .003). The risk-adjusted morbidity observed to expected ratios decreased at a uniform annual percentage change of −6.03% (P < .001). Unadjusted overall mortality rates also decreased between the 2 periods (1.76% to 1.26%; =  .05). There was no significant change in the risk-adjusted mortality observed to expected ratios during the study.

Conclusions The institution of an intern home call schedule was not associated with increased rates of postoperative morbidity or mortality.

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