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Citation
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Weaver MD, Landrigan CP, Sullivan JP, O'Brien CS, Qadri S, Viyaran N, Wang W, Vetter C, Czeisler CA, Barger LK. Am. J. Med. 2020; ePub(ePub): ePub. |
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Affiliation
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Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA; Division of Sleep Medicine, Harvard Medical School, Boston, MA. |
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Abstract
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BACKGROUND: In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety.
METHODS: All medical students matched to a United States residency program from 2002-2007 and 2014-2017 were invited to participate in prospective cohort studies. Each month participants reported hours of work, extended duration shifts, and adverse safety outcomes; including motor vehicle crashes, percutaneous injuries, and attentional failures. The incidence of each outcome was compared before and after the 2011 ACGME work-hour limit. Hypotheses were tested using generalized linear models adjusted for potential confounders.
RESULTS: 13% of all first-year resident physicians nationwide participated in the study, with 80,266 monthly reports completed by 15,276 first-year resident physicians. Following implementation of the 16-h 2011 ACGME work-hour limit, the mean number of extended duration (≥24-h) shifts per month decreased from 3.9 to 0.2. The risk of motor vehicle crash decreased 24% (RR 0.76; 0.67-0.85), percutaneous injury risk decreased more than 40% (RR 0.54; 0.48-0.61), and the rate of attentional failures was reduced 18% (IRR 0.82; 0.78-0.86). Extended duration shifts and prolonged weekly work hours were associated with an increased risk of adverse safety outcomes independent of cohort.
CONCLUSIONS: The 2011 ACGME work-hour limit was associated with meaningful improvements in physician safety and health. Surveillance is needed to monitor the ongoing impact of work hours on physician safety, health, and well-being.
Copyright © 2020. Published by Elsevier Inc.
Language: en |