Journal Article

1177 INCREASED RISK OF ADVERSE SAFETY OUTCOMES IN PGY1 RESIDENTS WORKING LONG WORK WEEKS AND ≥16-HOUR SHIFTS

Czeisler, CA, Wang, W, Weaver, MD, Qadri, S, Sullivan, JP, Landrigan, CP, O’Brien, C, Barger, LK, Vetter, C

2017

Overview

Abstract Introduction: Adverse safety outcomes are associated with extended-duration (≥ 24 hour) shifts worked by resident physicians. In 2011 the Accreditation Council for Graduate Medical Education (ACGME) implemented an 80-hour work week (averaged over 4 weeks) and a 16-hour limit on the number of consecutive hours that resident physicians may be scheduled to work in their first postgraduate year (PGY1). We sought to determine if long work weeks and shifts of 16 hours or greater was associated with adverse safety outcomes in PGY1 resident physicians. Methods: Graduating medical students who registered for the National Residency Matching Program were invited to participate in a nationwide survey. From July 2014 to May 2016, residents completed online monthly surveys reporting their work hours, shift lengths, near-crashes and percutaneous injuries. We used linear and generalized linear regression models to estimate the risk of adverse safety outcomes associated with work hours (≤80 and >80 hours/week) and number of shifts that were at least 16 hours (16h; none, 1–4, >4). Age, gender, and BMI were controlled as covariates. Results: 7,345 PGY1 residents completed 46,871 monthly surveys. Compared to those PGY1 residents working ≤80 hours per week with no 16-hour shifts, PGY1 residents working ≤ 80 hours with 1–4 16h shifts had an increased risk of near-crashes (adjusted odds ratio 1.45, 95% CI 1.29–1.61). Residents working ≤ 80 hours with >4 16h shifts had an increased risk of near crashes (1.72, 1.42–2.08). Residents working > 80 hours with 1–4 and > 4 16h shifts had an increased risk of near-crashes (1.89, 1.47–2.42; 2.50, 1.91–3.27) and percutaneous injuries (2.71, 1.79–4.10; 2.49, 1.61–3.86), respectively. Conclusion: PGY1 resident safety is negatively affected by shifts of 16 or more hours, as well as by working >80 hours per week. The ACGME’s current proposal to eliminate the 16-hour consecutive work limit for PGY1 residents could significantly increase the occurrence of adverse safety outcomes in this vulnerable population, and is inconsistent with the ACGME’s stated commitment to the well-being of residents. Support (If Any): National Institute for Occupational Safety and Health R01OH010300.

• Publisher: Oxford University Press
• Subject: Well being / Working hours / Workweeks