Impact of Eliminating Extended Duration Work Shifts on Resident Health and Safety

描述（由申请人提供）：经皮损伤及其伴随的肝炎、艾滋病毒和其他血液传播疾病的风险是住院医师面临的最大职业危害，机动车碰撞（MVC）是其年龄组死亡的主要原因。我们在全国范围内对2737名研究生一年级（PGY1s）的住院医师进行了调查，发现长时间轮班（bbb24小时）与73%的经皮损伤风险增加和168%的上下班途中的机动车碰撞（MVCs）增加有关。我们发现，当pgy1每月至少工作一次或多次长时间轮班时，他们也更有可能在开车时睡着。基于这些和类似的发现，2009年，医学研究所（IOM）建议，并于2011年，研究生医学教育认证委员会（ACGME）实施了住院医师在其研究生第一年的连续工作时数限制为16小时。并称：“为了确定新规定的效果，将像2002∼2007年进行的调查一样，在全国范围内对实习生进行大规模调查。”我们将通过每月网络调查收集工作时间和睡眠数据以及健康和安全结果。我们建议测试以下假设：在新的ACGME共同计划要求（2011年）下工作的PGY1居民中，睡眠将增加，MVCs和经皮损伤的发生率将降低，该要求将工作时间限制在连续16小时，与我们之前从6,487名PGY1（47,858个月调查）中收集的数据相比，该限制实施之前。我们也会测试睡眠时间会增加的假设

DESCRIPTION (provided by applicant): Percutaneous injuries, with their attendant risk of hepatitis, HIV, and other blood-borne illnesses, are the greatest occupational hazard faced by resident physicians and motor vehicle crashes (MVC) are the leading cause of death in their age group. In our nationwide survey of 2,737 resident physicians in their first postgraduate year (PGY1s) we found that extended duration work shifts (> 24 hours) were associated with a 73% increase in the risk of percutaneous injuries and a 168% increase in motor vehicle crashes (MVCs) on the commute from work. We found that PGY1s were also significantly more likely to report falling asleep while driving when they worked at least one or more extended duration shifts per month. Based on these and similar findings, in 2009, the Institute of Medicine (IOM) recommended and in 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented, a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year. In order to determine the effectiveness of the new work hour rule, we propose to conduct a large-scale nationwide survey of interns, similar to that which we conducted from 2002-2007. We will collect work hours and sleep data as well as health and safety outcomes on monthly web-based surveys. We propose to test the hypotheses that sleep will be increased, and the incidence rates of MVCs and percutaneous injuries will be decreased among PGY1 residents working under the new ACGME Common Program Requirements (2011) that limit the duration of work shifts to 16 consecutive hours as compared to data we previously collected from 6,487 PGY1s (47,858 monthly surveys) prior to implementation of this limit. We will also test the hypotheses that sleep will be increased and the incidence rates of MVCs and percutaneous injuries will be decreased among PGY1 residents whose work shifts are limited to 16 consecutive hours as compared to those same residents in their PGY2+ years who are scheduled to work extended duration (>24 hours) shifts. The proposed study could have important public policy implications related to the health and safety of the more than 108,000 medical and surgical residents, who are the principal providers of medical care in academic medical centers throughout the United States.