NIOSHTIC-2 Publications Search

The association between resident physician work-hour regulations and physician safety and health.

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 Jul; 133(7):e343-e354

https://doi.org/10.1016/j.amjmed.2019.12.053

20059103

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.

Physicians; Work schedules; Sleep deprivation; Long work hours; Health care personnel; Cohort studies; Author Keywords: physicians; work hours; safety; sleep