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，是住院医生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。在我们对2，737名研究生第一年（PGY 1）住院医师的全国性调查中，我们发现，长时间轮班（> 24小时）与经皮损伤风险增加73%和上下班途中机动车碰撞（MVC）增加168%相关。我们发现，PGY 1也更有可能报告说，当他们每月至少工作一次或多次长时间轮班时，他们在开车时睡着了。 基于这些和类似的研究结果，2009年，医学研究所（IOM）建议，2011年，研究生医学教育认证理事会（ACGME）实施了住院医师在第一个研究生年度可以安排工作的连续小时数限制为16小时。 为了确定新的工作时间规则的有效性，我们建议对实习生进行一次大规模的全国性调查，类似于我们在2002-2007年期间进行的调查。我们将收集工作时间和睡眠数据，以及每月基于网络的调查的健康和安全结果。我们建议检验以下假设：与我们之前从6，487名PGY 1居民中收集的数据相比，在新的ACGME共同计划要求（2011年）下工作的PGY 1居民中，睡眠将增加，MVC和经皮损伤的发生率将降低，该要求将轮班时间限制为连续16小时（47，858次月度调查）。我们还将测试睡眠会增加的假设， 与计划工作时间延长（>24小时）的PGY 2+年的居民相比，PGY 1居民的工作班次限制在连续16小时内，MVC和经皮损伤的发生率将降低。 这项拟议的研究可能会对超过108，000名医疗和外科住院医生的健康和安全产生重要的公共政策影响，这些住院医生是美国学术医疗中心的主要医疗服务提供者。

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.