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In 2003, the Accreditation Council for Graduate Medical Education instituted resident duty-hour restrictions to reduce morbidity and mortality because of medical errors at teaching hospitals. This observational study compared mortality rates at 131 Veterans Affairs (VA) hospitals during the 3 years before and 2 years after the reforms were implemented. The study included 318,636 patients admitted with diagnoses of acute myocardial infarction, congestive heart failure, gastrointestinal bleed, stroke, general surgery, orthopedic surgery, or vascular surgery. Resident-to-bed ratios, ranging from 0 (nonteaching) to 1, were used as a proxy for teaching intensity.
During the second year after reform, the odds of mortality were significantly lower …