Landrigan Christopher P, Barger Laura K, Cade Brian E, Ayas Najib T, Czeisler Charles A
Harvard Work Hours, Health and Safety Group, Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass 02115, USA.
JAMA. 2006 Sep 6;296(9):1063-70. doi: 10.1001/jama.296.9.1063.
Sleep deprivation is associated with increased risk of serious medical errors and motor vehicle crashes among interns. The Accreditation Council for Graduate Medical Education (ACGME) introduced duty-hour standards in 2003 to reduce work hours.
To estimate compliance with the ACGME duty-hour standards among interns.
DESIGN, SETTING, AND PARTICIPANTS: National prospective cohort study with monthly Web-based survey assessment of intern work and sleep hours using a validated instrument, conducted preimplementation (July 2002 through May 2003) and postimplementation (July 2003 through May 2004) of ACGME standards. Participants were 4015 of the approximately 37 253 interns in US residency programs in all specialties during this time; they completed 29 477 reports of their work and sleep hours.
Overall and monthly rates of compliance with the ACGME standards.
Postimplementation, 1068 (83.6%; 95% confidence interval [CI], 81.4%-85.5%) of 1278 of interns reported work hours in violation of the standards during 1 or more months. Working shifts greater than 30 consecutive hours was reported by 67.4% (95% CI, 64.8%-70.0%). Averaged over 4 weeks, 43.0% (95% CI, 40.3%-45.7%) reported working more than 80 hours weekly, and 43.7% (95% CI, 41.0%-46.5%) reported not having 1 day in 7 off work duties. Violations were reported during 3765 (44.0%; 95% CI, 43.0%-45.1%) of the 8553 intern-months assessed postimplementation (including vacation and ambulatory rotations), and during 2660 (61.5%; 95% CI, 60.0%-62.9%) of 4327 intern-months during which interns worked exclusively in inpatient settings. Postimplementation, 29.0% (95% CI, 28.7%-29.7%) of reported work weeks were more than 80 hours per week, 12.1% (95% CI, 11.8%-12.6%) were 90 or more hours per week, and 3.9% (95% CI, 3.7%-4.2%) were 100 or more hours per week. Comparing preimplementation to postimplementation responses, reported mean work duration decreased 5.8% from 70.7 (95% CI, 70.5-70.9) hours to 66.6 (95% CI, 66.3-66.9) hours per week (P<.001), and reported mean sleep duration increased 6.1% (22 minutes) from 5.91 (95% CI, 5.88-5.94) hours to 6.27 (95% CI, 6.23-6.31) hours per night (P<.001). However, reported mean sleep during extended shifts decreased 4.5%, from 2.69 (95% CI, 2.66-2.73) hours to 2.57 (95% CI, 2.52-2.62) hours (P<.001).
In the first year following implementation of the ACGME duty-hour standards, interns commonly reported noncompliance with these requirements.
睡眠不足与实习医生出现严重医疗失误及机动车碰撞事故的风险增加有关。毕业后医学教育认证委员会（ACGME）于2003年出台了工作时长标准以减少工作时间。
评估实习医生对ACGME工作时长标准的遵守情况。
设计、地点和参与者：一项全国性前瞻性队列研究，在ACGME标准实施前（2002年7月至2003年5月）和实施后（2003年7月至2004年5月），使用经过验证的工具通过基于网络的月度调查对实习医生的工作和睡眠时间进行评估。在此期间，美国各专业住院医师培训项目中约37253名实习医生中的4015名参与了研究；他们完成了29477份关于工作和睡眠时间的报告。
遵守ACGME标准的总体及月度比率。
在标准实施后，1278名实习医生中有1068名（83.6%；95%置信区间[CI]，81.4% - 85.5%）报告在1个或更多月份工作时长违反标准。67.4%（95%CI，64.8% - 70.0%）的人报告连续工作超过30小时。平均四周来看，43.0%（95%CI，40.3% - 45.7%）的人报告每周工作超过80小时，43.7%（95%CI，41.0% - 46.5%）的人报告没有连续7天中的1天休息。在实施后评估的8553个实习医生月（包括假期和门诊轮转）中，有3765个（44.0%；95%CI，43.0% - 45.1%）报告存在违规情况，在实习医生仅在住院部工作的4327个实习医生月中，有2660个（61.5%；95%CI，60.0% - 62.9%）报告存在违规情况。标准实施后，报告的工作周中29.0%（95%CI，28.7% - 29.7%）每周超过80小时，12.1%（95%CI，11.8% - 12.6%）每周90小时或更长时间，3.9%（95%CI，3.7% - 4.2%）每周100小时或更长时间。将实施前与实施后的回答进行比较，报告的平均工作时长从每周70.7（95%CI，70.5 - 70.9）小时减少了5.8%，降至66.6（95%CI，66.3 - 66.9）小时（P <.001），报告的平均睡眠时间从每晚5.91（95%CI，5.88 - 5.94）小时增加了6.1%（22分钟），至6.27（95%CI，6.23 - 6.31）小时（P <.001）。然而，长时间轮班期间报告的平均睡眠时间减少了4.5%，从2.69（95%CI，2.66 - 2.73）小时降至2.57（95%CI，2.52 - 2.62）小时（P <.001）。
在ACGME工作时长标准实施后的第一年，实习医生普遍报告未遵守这些要求。
