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Within neurosurgery, the national mandate of the 2003 duty hour restrictions (DHR) by the Accreditation Council for Graduate Medical Education (ACGME) has been controversial. Ensuring the proper education and psychological well-being of residents while fulfilling the primary purpose of patient care has generated much debate. Most medical disciplines have developed strategies that address service needs while meeting educational goals. Additionally, there are numerous studies from those disciplines; however, they are not specifically relevant to the needs of a neurosurgical residency. The recent implementation of the 2011 DHR specifically aimed at limiting interns to 16-hour duty shifts has proven controversial and challenging across the nation for neurosurgical residencies--again bringing education and service needs into conflict. In this report the current literature on DHR is reviewed, with special attention paid to neurosurgical residencies, discussing resident fatigue, technical training, and patient safety. Where appropriate, other specialty studies have been included. The authors believe that a one-size-fits-all approach to residency training mandated by the ACGME is not appropriate for the training of neurosurgical residents. In the authors' opinion, an arbitrary timeline designed to limit resident fatigue limits patient care and technical training, and has not improved patient safety.

Objective The Hospital Readmission Reduction Program section of the Patient Protection and Affordable Care Act uses readmission rates as a proxy for measuring quality of care. Multiple studies have demonstrated that readmission rates are highly imprecise proxies for quality of care because readmission rates contain large amounts of statistical noise and are dependent on disease type, insurance type, severity, population, and a multitude of other factors. The current study was conducted to investigate characteristics associated with readmission and the quality of neurosurgical care. Methods Admissions data were gleaned from the University Health System Consortium database for neurosurgical patient (both cranial and spine) readmissions to assess patient-related factors relating to readmission from January 2011 to December 2014. Results Among 257,212 admissions for neurosurgical disease analyzed, patients with Medicaid and private payers as a primary insurance source had increased rates of readmission (odds ratio for readmission of 1.38 and 1.17, respectively) compared with patients with Medicare or other primary insurers. Patients with greater severity of disease and emergent or urgent admission also had statistically significant rates of readmission. Conclusions The findings suggest that readmission is affected by patient factors that are beyond the control of treating physicians. These findings also suggest that readmission rates may not be a good proxy for measurement of quality of care in neurosurgical patients. [ABSTRACT FROM AUTHOR]