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

描述(申请人提供)：经皮损伤，伴随着肝炎、艾滋病毒和其他血液传播疾病的风险，是驻院医生面临的最大职业危险，机动车碰撞(MVC)是他们年龄段的主要死亡原因。在我们对2,737名研究生第一年(PGY1)的全国住院医师进行的调查中，我们发现，延长轮班时间(&gt；24小时)与经皮损伤风险增加73%，在下班通勤途中发生机动车撞车事故(MVC)增加168%。我们发现，当PGY1每个月至少工作一次或更多延长持续时间班次时，他们在开车时睡着的可能性也明显更大。根据这些和类似的调查结果，2009年，医学研究所(IOM)建议，2011年，医学研究生教育认证委员会(ACGME)对驻院医生在研究生第一年的连续工作时间限制为16小时。为了确定新工时规定的有效性，我们建议在全国范围内对实习生进行大规模调查，类似于我们在2002-2007年进行的调查。我们将通过每月基于网络的调查收集工作时间和睡眠数据以及健康和安全结果。我们建议测试假设，即在新的ACGME共同计划要求(2011)下工作的PGY1居民的睡眠将增加，MVC和经皮损伤的发生率将降低，与我们之前从实施这一限制之前的6,487个PGY1(47,858个月调查)收集的数据相比，新的ACGME共同计划要求(2011)将工作时间限制为连续16小时。我们还将测试睡眠将会增加的假设，以及 与那些计划延长工作时间(&gt；24小时)的PGY1居民相比，工作班次限制在连续16小时内的PGY1居民的MVC和皮肤损伤的发生率将会降低。这项拟议的研究可能会对超过10.8万名内科和外科住院医生的健康和安全产生重要的公共政策影响，这些住院医生是全美学术医疗中心的主要医疗保健提供者。

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.