Longitudinal Study of Fatigue, Stress, and Work Organization as Risk Factors for Motor Vehicle Crash Risk in Surgical Residents

摘要 这份为期3年的K01提案旨在解决医疗保健和社会援助Nora部门的目标1： “评估工作组织如何影响工人和病人的安全”，特别是通过其直接 与跨行业的健康工作设计和幸福感相关。这项建议解决了一个高度优先的问题 在2019-2023年NIOSH战略目标中概述的领域是改善安全和健康的工作设计和良好的- 在常住人口中：中期目标7.2C“疲劳、压力、工作组织为风险” 机动车在通勤和轮班期间发生撞车事故的因素。汽车碰撞(MVC)是一种 导致MVC的主要死因和主要因素是驾驶疲劳。困倦、疲惫和压力， 在外科住院医生中很常见，对驾驶安全产生负面影响。平衡居民的福祉和 实习期间必要的培训时间和工作量长期以来一直是争论的主题。尽管一个令人担忧的问题 在医护人员中，居民幸福感和工作组织因素与撞车风险的关系 得到的研究很少。这项研究的中心假设是幸福感和工作组织的衡量标准 预测外科住院医生的撞车风险，因为住院医生的幸福感和工作组织可能 随着时间的推移而变化，撞车风险也会随着时间的推移而变化。研究计划和职业生涯的长期目标 训练是将受伤风险的轨迹表征为幸福感和工作组织的函数，以及 将调查结果转化为在医疗保健工作环境中实施的循证干预措施。在这个ITS的第一次 50名外科住院医师的幸福感、工作组织和驾驶表现的纵向研究将 在超过18个月的时间里接受监测。纵向设计允许研究居民的幸福感和撞车风险 通过转移工作组织要素。多种方法将在4岁时衡量幸福感和推动结果 超过18个月的时间点，包括对睡眠的客观测量(手表活动记录仪)，职业 压力(唾液皮质醇)，以及具有先进眼球跟踪功能的高保真驾驶模拟器，提供详细的 衡量撞车和昏昏欲睡驾驶风险的指标。目标1：描述员工幸福感的轨迹(睡眠、 疲劳和压力)和工作组织(箱子负荷、值班开始/结束时间、班次持续时间)对撞车风险的影响 超过18个月的住院医生。目标2：描述事故风险在18个月内的发展轨迹 实习医生。MVC对社会来说是昂贵的，而且在外科住院医生中研究不足。建议的研究结果 工作有可能通过制定关于值班时间和工作量的标准来减少MVC 住院医师培训。这个K奖将推动PI职业生涯的下一步：使用 从研究到实践(R2P)方法进行干预研究，开发和评估培训 工作时间长的居民。这项未来的研究将检查工作设计的有效性 拟议研究的结果和减轻医疗保健造成的机动车碰撞负担 工人们。

ABSTRACT This 3-year K01 proposal seeks to address the Healthcare & Social Assistance NORA sector, objective 1: “Assess how work organization impacts both worker and patient safety” specifically through its direct relevance to the Healthy Work Design and Well-being cross-sector. This proposal addresses a high priority area outlined in the 2019-2023 NIOSH strategic goals to improve safe and healthy work design and well- being in the resident population: Intermediate Goal 7.2C “Fatigue, stress, work organization as risk factors for motor vehicle crashes during commutes and shifts.” Motor vehicle crashes (MVCs) are a leading cause of death and a major contributor to MVCs is driver fatigue. Sleepiness, fatigue, and stress, common among surgical residents, negatively impact driving safety. Balancing resident well-being with the necessary training hours and caseloads during residency has long been subject to debate. Although a concern among healthcare workers, the relationship of resident well-being and work organization factors with crash risk have received little study. The study's central hypothesis is that measures of well-being and work organization predict crash risk among surgical residents, and because resident well-being and work organization may change over time, crash risk changes over time. The long-term goal of the research program and career training is to characterize the trajectory of injury risk as a function of well-being and work organization and translate findings to evidence-based interventions implemented in healthcare work settings. In this first-of-its kind longitudinal study, the well-being, work organization, and driving performance of 50 surgical residents will be monitored over 18 months. The longitudinal design permits the study of resident well-being and crash risk through shifting work organization factors. Multiple methods will measure well-being and driving outcomes at 4 time points over 18 months, including objective measurements of sleep (wristwatch actigraphy), occupational stress (salivary cortisol), and a high fidelity driving simulator with advanced eye tracking providing detailed metrics of crash and drowsy driving risk. Aim 1: Characterize the trajectory of worker well-being (sleep, fatigue, and stress) and work organization (case load, duty start/end times, shift duration) on crash risk over 18 months of residency. Aim 2: Characterize the trajectory of crash risk over 18 months of residency. MVCs are costly to society and understudied in surgical residents. The findings of the proposed work have the potential to reduce MVCs by shaping standards regarding duty hours and caseloads during residency training. This K award will propel the next step of the PI's career: submitting an R grant using a Research to Practice (r2p) approach to conduct an intervention study developing and evaluating training for residents on long work hours. This future research will examine effectiveness of work designs informed by the findings of the proposed research and reduce the burden of motor vehicle crashes sustained by healthcare workers.