The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health
The Association Between Resident Physician Work-Hour Regulations and Physician Safety and Health
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DOI：
10.1016/j.amjmed.2019.12.053
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发表时间：
2020-07-01
影响因子：
5.9
通讯作者：
Barger, Laura K.
中科院分区：
文献类型：
--
作者：
Weaver, Matthew D.;Landrigan, Christopher P.;Barger, Laura K.
背景：2011年，研究生医学教育认证委员会（ACGME）制定了第一年住院医师连续工作16小时的限制。我们试图检查这些工作时间规定对医生安全的影响。方法：所有2002 - 2007年和2014 - 2017年与美国住院医师项目匹配的医学生被邀请参加前瞻性队列研究。每个月参与者都报告了工作时间、延长的轮班时间和不利的安全结果，包括机动车碰撞、经皮损伤和注意力不集中。比较2011年ACGME工作时间限制前后各结果的发生率。假设检验使用广义线性模型调整潜在的混杂因素。结果：在全国所有的第一年住院医师中，13%的人参与了这项研究，15276名第一年住院医师完成了80,266份月度报告。在实施2011年16小时ACGME工作时间限制后，每月延长轮班（>= 24小时）的平均次数从3.9次减少到0.2次。机动车碰撞风险降低24%（相对危险度[RR] 0.76; 0.67-0.85），经皮损伤风险降低40%以上（相对危险度[RR] 0.54; 0.48-0.61），注意力不集中率降低18%（发病率比[IRR] 0.82; 0.78-0.86）。延长轮班时间和延长每周工作时间与不良安全结果的风险增加相关，与队列无关。结论：2011年ACGME工作时间限制与医师安全和健康有意义的改善相关。需要进行监测，以监测工作时间对医生安全、健康和福祉的持续影响。(C) 2020爱思唯尔公司版权所有。
BACKGROUND: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety.METHODS: All medical students matched to a US residency program from 2002 to 2007 and 2014 to 2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes, including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders.RESULTS: Of all first-year resident physicians nationwide, 13% participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (>= 24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (relative risk [RR] 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (relative risk 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (incidence rate ratio [IRR] 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort.CONCLUSIONS: The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being. (C) 2020 Elsevier Inc. All rights reserved.