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

研究生医学教育认证理事会（ACGME）最近改变了 管理美国居民工作时间的政策，可能影响安全， 这一职业群体的健康和福祉。经皮损伤（PI）及其伴随者 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， 住院医师面临的危险和机动车碰撞（MVC）是导致 死亡在他们的年龄组。在我们以前的工作中，我们发现，延长持续时间的变化（≥ 24 小时）与第一年上班通勤的MVC增加了168%相关 研究生居民（PGY 1）和PI的风险增加73%。针对这些 根据调查结果，2011年ACGME对PGY 1工作班次实施了16小时的限制。随后，委员会注意到， 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份PGY 1，并将这些数据与 以前从2002-2007年的5，680份PGY 1（30，848份月度报告）中收集， 经常加班根据2011年ACGME政策，每晚睡眠时间 增加，MVC的风险降低25%，PI的风险降低44%。PGY 1健康 改善，呼吸系统疾病减少25%，运动量显著增加。 尽管有这些改进，ACGME在2017年取消了这些工作时间限制。我们 我们有独特的优势，可以立即直接评估这一政策变化的影响。通过 继续监督PGY 1工作时间，安全，健康和福利结果与我们的 在全国范围内的调查中，我们将讨论诺拉“医疗保健和社会援助”部门， 跨部门的“健康工作设计和福利方案”。我们将检验 MVCs、近碰撞和经皮损伤的发生率将增加， 在2017年ACGME政策下工作的PGY 1学生中，居民福祉将下降 允许长时间转换。我们的研究将“促进安全和健康的工作设计 和福祉”，NIOSH的七个战略目标之一（具体而言，7.2A和7.2C）。我们计划 通过计划的产出广泛传播这项研究所获得的知识（以高 影响出版物）。根据NIOSH的研究实践倡议，我们计划参与 通过在国家论坛上介绍我们的研究，向主要利益攸关方提供信息。当政策改变时，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 改善超过10万居民的安全、健康和福祉（最终成果） 医生，他们是美国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.