Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities
Association of workload of on-call medical interns with on-call sleep duration, shift duration, and participation in educational activities
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DOI：
10.1001/jama.300.10.1146
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发表时间：
2008-09-10
影响因子：
120.7
通讯作者：
Meltzer, David O.
中科院分区：
文献类型：
--
作者：
Arora, Vineet M.;Georgitis, Emily;Meltzer, David O.
背景进一步限制居民值班时间正在考虑中，重要的是要了解工作量，睡眠不足，轮班时间之间的关联，和随叫随到的医疗实习生的教育时间。目的评估是否增加随叫随到的实习生的工作量，作为衡量的新入院随叫随到的数量和以前入院的病人数量仍然在服务，与随叫随到睡眠减少、总轮班时间增加和参与教育活动的可能性降低有关。设计、设置和参与者对2003年7月1日至2005年6月24日在美国一个学术医学中心的医学实习生进行的前瞻性队列研究。在81名实习医生中，56人参与（69%），共165个普通内科住院月，导致1100个呼叫nights.Main结果测量随叫随到的睡眠时间，通过手表活动记录估计;参与教育活动（说教式讲座或床边教学），结果随叫随到的平均睡眠时间为2.8（1.5）小时，平均（SD）偏移持续时间为29.9（1.7）小时。实习生报告说，他们花了11%的时间在教育活动上。在学年的早期（7月至10月），每次新的随叫随到的入院与睡眠减少相关（-10.5分钟[ 95%置信区间{CI}，-16.8至-4.2分钟]; P
Context Further restrictions in resident duty hours are being considered, and it is important to understand the association between workload, sleep loss, shift duration, and the educational time of on-call medical interns.Objective To assess whether increased on- call intern workload, as measured by the number of new admissions on- call and the number of previously admitted patients remaining on the service, was associated with reductions in on- call sleep, increased total shift duration, and lower likelihood of participation in educational activities.Design, Setting, and Participants Prospective cohort study of medical interns at a single US academic medical center from July 1, 2003, through June 24, 2005. Of the 81 interns, 56 participated ( 69%), for a total of 165 general medicine inpatient months resulting in 1100 call nights.Main Outcome Measures On- call sleep duration, estimated by wrist watch actigraphy; total shift duration, measured from paging logs; and participation in educational activities ( didactic lectures or bedside teaching), measured by experience sampling method via a personal digital assistant.Results Mean ( SD) sleep duration on- call was 2.8 ( 1.5) hours and mean ( SD) shift duration was 29.9 ( 1.7) hours. Interns reported spending 11% of their time in educational activities. Early in the academic year ( July to October), each new on- call admission was associated with less sleep (- 10.5 minutes [ 95% confidence interval {CI}, - 16.8 to - 4.2 minutes]; P