Longitudinal Study of Fatigue, Stress, and Work Organization as Risk Factors for Motor Vehicle Crash Risk in Surgical Residents

摘要 这份为期3年的K 01提案旨在解决医疗保健和社会援助诺拉部门的目标1： “评估工作组织如何影响工人和病人的安全”，特别是通过其直接 与健康工作设计和福利跨部门的相关性。这项建议涉及一个高度优先事项， 2019-2023年NIOSH战略目标中概述的领域，以改善安全和健康的工作设计， 在常住人口中：中期目标7.2C“疲劳、压力、工作安排风险 在通勤和轮班期间发生车祸的因素。”机动车碰撞（MVC）是一种 驾驶员疲劳是导致死亡的主要原因，也是造成车辆交通事故的主要原因。嗜睡、疲劳和压力， 在外科住院医生中很常见，对驾驶安全产生负面影响。平衡居民福利与 长期以来，关于住院期间所需的培训时间和案件量一直存在争议。虽然关注 在医护人员中，居民幸福感和工作组织因素与撞车风险的关系 很少有人研究。这项研究的中心假设是，幸福和工作组织的措施， 预测外科住院医生的撞车风险，因为住院医生的健康和工作组织可能 随着时间的推移而变化，崩溃风险随着时间的推移而变化。研究计划和职业生涯的长期目标 培训的目的是将伤害风险的轨迹描述为福利和工作组织的功能， 将调查结果转化为在医疗保健工作环境中实施的循证干预措施。在这第一次 种纵向研究，幸福，工作组织，和驾驶性能的50外科住院医师将 监测18个月以上。纵向设计允许研究居民的健康和碰撞风险 通过改变工作组织因素。多种方法将衡量幸福和驱动结果在4 18个月内的时间点，包括睡眠的客观测量（腕动计），职业 压力（唾液皮质醇）和高保真驾驶模拟器，先进的眼动跟踪提供详细的 车祸和疲劳驾驶风险的指标。目标1：描述工人幸福感的轨迹（睡眠， 疲劳和压力）和工作组织（案例负载、工作开始/结束时间、轮班持续时间）对碰撞风险的影响 超过18个月的住院实习目标2：描述18个月内坠机风险的轨迹， 居住权MVCs对社会来说是昂贵的，在外科住院医师中研究不足。建议的调查结果 工作有可能通过制定有关工作时间和工作量的标准来减少MVC。 住院医师培训这个K奖将推动PI职业生涯的下一步：使用 研究到实践（r2 p）的方法，进行干预研究，制定和评估培训， 居民长时间工作。这项未来的研究将检查工作设计的有效性， 拟议研究的结果，并减少医疗保健持续的机动车碰撞的负担 工人

ABSTRACT This 3-year K01 proposal seeks to address the Healthcare & Social Assistance NORA sector, objective 1: “Assess how work organization impacts both worker and patient safety” specifically through its direct relevance to the Healthy Work Design and Well-being cross-sector. This proposal addresses a high priority area outlined in the 2019-2023 NIOSH strategic goals to improve safe and healthy work design and well- being in the resident population: Intermediate Goal 7.2C “Fatigue, stress, work organization as risk factors for motor vehicle crashes during commutes and shifts.” Motor vehicle crashes (MVCs) are a leading cause of death and a major contributor to MVCs is driver fatigue. Sleepiness, fatigue, and stress, common among surgical residents, negatively impact driving safety. Balancing resident well-being with the necessary training hours and caseloads during residency has long been subject to debate. Although a concern among healthcare workers, the relationship of resident well-being and work organization factors with crash risk have received little study. The study's central hypothesis is that measures of well-being and work organization predict crash risk among surgical residents, and because resident well-being and work organization may change over time, crash risk changes over time. The long-term goal of the research program and career training is to characterize the trajectory of injury risk as a function of well-being and work organization and translate findings to evidence-based interventions implemented in healthcare work settings. In this first-of-its kind longitudinal study, the well-being, work organization, and driving performance of 50 surgical residents will be monitored over 18 months. The longitudinal design permits the study of resident well-being and crash risk through shifting work organization factors. Multiple methods will measure well-being and driving outcomes at 4 time points over 18 months, including objective measurements of sleep (wristwatch actigraphy), occupational stress (salivary cortisol), and a high fidelity driving simulator with advanced eye tracking providing detailed metrics of crash and drowsy driving risk. Aim 1: Characterize the trajectory of worker well-being (sleep, fatigue, and stress) and work organization (case load, duty start/end times, shift duration) on crash risk over 18 months of residency. Aim 2: Characterize the trajectory of crash risk over 18 months of residency. MVCs are costly to society and understudied in surgical residents. The findings of the proposed work have the potential to reduce MVCs by shaping standards regarding duty hours and caseloads during residency training. This K award will propel the next step of the PI's career: submitting an R grant using a Research to Practice (r2p) approach to conduct an intervention study developing and evaluating training for residents on long work hours. This future research will examine effectiveness of work designs informed by the findings of the proposed research and reduce the burden of motor vehicle crashes sustained by healthcare workers.