Impact of lifting work hour restrictions on first-year resident safety, health and well-being

医学研究生教育认证委员会(ACGME)最近改变了 美国管理居民工作时间的政策，可能会影响安全， 这一职业群体的健康和福祉。经皮损伤(PI)及其随行人员 患肝炎、艾滋病毒和其他血液传播疾病的风险是最大的职业之一 住院医生面临的危险和机动车撞车(MVC)是导致 在他们的年龄段中死亡。在我们之前的工作中，我们发现延长持续时间的移位(≥24 小时)与第一年上下班通勤的MVC增加168%有关 研究生住院医生(PGY1)和PI风险增加73%。在回应这些问题时 根据调查结果，2011年，ACGME对PGY1工作班次实施了16小时的限制。后来， 从2014年7月到2017年5月，我们收集了工作时间、安全、健康和福祉结果 从49,418份基于网络的月度报告中的9,596个PGY1，并将这些数据与 以前收集自2002-2007年的5,680个PGY1(30,848个月报告)，当时PGY1 例行公事地加班。根据2011年ACGME政策，每晚睡眠时间 增加，MVC风险降低25%，PI风险降低44%。PGY1幸福指数 有所改善，呼吸系统疾病减少了25%，锻炼显著增加。 尽管有这些改进，ACGME在2017年取消了这些工作时间限制。我们是 独一无二的定位，能够立即、直接地评估这一政策变化的影响。通过 继续监测PGY1的工作时间、安全、健康和福利结果 全国范围内的调查，我们将解决Nora的“医疗和社会援助”部门和 “健康工作设计及福祉计划”跨界别。我们将检验这些假设 MVC、险些撞车和经皮损伤的发生率将会增加， 在2017年ACGME政策下工作的PGY1人的居民幸福感将会下降 这就允许延长持续时间。我们的研究将“促进安全和健康的工作设计 和幸福，“NIOSH的七个战略目标之一(具体地说，7.2a和7.2c)。我们计划 通过计划产出广泛传播通过这项研究获得的知识(高 影响出版物)。根据NIOSH研究实践倡议，我们计划参与 通过在国家论坛上展示我们的研究成果，为关键利益攸关方提供支持。随着策略的更改和/或 医院利用从这项研究中获得的工作设计知识，我们希望 改善100,000名居民的安全、健康和福祉(最终结果) 医生，他们是全美学术医疗中心的主要护理提供者。

The Accreditation Council for Graduate Medical Education (ACGME) recently changed the policy governing resident work hours in the United States, potentially impacting the safety, health, and well-being of this occupational group. Percutaneous injuries (PI), with their attendant risk of hepatitis, HIV, and other blood-borne illnesses, are one of the greatest occupational hazards faced by resident physicians and motor vehicle crashes (MVC) are a leading cause of death in their age group. In our previous work, we found that extended-duration shifts (≥ 24 hours) are associated with a 168% increase in MVCs on the commute from work in first-year postgraduate residents (PGY1s) and a 73% increase in the risk of PI. In response to these findings, in 2011 the ACGME implemented a 16-hour limit for PGY1 work shifts. Subsequently, from July 2014-May 2017, we collected work hours, safety, health and well-being outcomes from 9,596 PGY1s on 49,418 monthly web-based reports and compared these data to those previously collected from 5,680 PGY1s (30,848 monthly reports) from 2002-2007 when PGY1s routinely worked extended-duration shifts. Under the 2011 ACGME policy, nightly hours of sleep increased, risk of an MVC decreased 25% and risk of PI decreased 44%. PGY1 well-being improved, with a 25% reduction in respiratory illness and a significant increase in exercise. Despite these improvements, the ACGME lifted these work hour restrictions in 2017. We are uniquely positioned to immediately and directly evaluate the effect of this policy change. By continuing to surveille PGY1 work hours, safety, health and well-being outcomes with our nationwide survey, we will address the NORA “Healthcare and Social Assistance” sector and the “Healthy Work Design and Well-Being Program” cross-sector. We will test the hypotheses that the incidence rates of MVCs, near-crashes and percutaneous injuries will be increased and resident well-being will be decreased among PGY1s working under the 2017 ACGME policy that permits extended duration shifts. Our research will “Promote safe and healthy work design and well-being,” one of NIOSH's seven strategic goals (specifically, 7.2A and 7.2C). We plan to widely disseminate the knowledge gained by this research through planned outputs (in high- impact publications). In line with the NIOSH Research to Practice initiative, we plan to engage key stakeholders by presenting our research in national forums. As policies are changed and/or hospitals utilize the knowledge of work design garnered from this research, we expect improvements in the safety, health and well-being (end outcomes) of >100,000 resident physicians, who are the principal providers of care in academic medical centers across the US.