Department of Surgery, Newton Wellesley Hospital, MA 02462, USA.
Am J Surg. 2013 Feb;205(2):163-8. doi: 10.1016/j.amjsurg.2012.10.006.
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) eliminated 30-hour call in an attempt to improve resident wakefulness. We surveyed interns on the Newton Wellesley Hospital (NWH) surgery service before and after the transition from Q4 overnight call to a night float schedule.
For 15 weeks, interns completed weekly surveys including the Epworth Sleepiness Scale (ESS). The service changed to a night float schedule after 3 weeks (ie, first to 3-4 and then to 6 nights in a row).
The average ESS score rose from 9.8 ± 5.2 to 14.9 ± 3.1 and 14.4 ± 4.5 (P = .042) on the 3/4 and 6/1 schedules, respectively. Interns were more likely to be abnormally tired on either night float schedule (relative risk = 2.86; 95% confidence interval, 1.17-6.97, P = .029).
The new ACGME work hours increased the ESS scores among interns at NWH and caused interns to be more tired than interns on the Q4 schedule. This is likely caused by the multiple nights of poor sleep without a post-call day to make up sleep.
2011 年 7 月 1 日，美国毕业后医学教育认证委员会（ACGME）为了提高住院医师的清醒程度，取消了 30 小时的轮班。我们调查了牛顿威尔斯利医院（NWH）外科服务的住院医师，在从 Q4 过夜值班过渡到夜间轮班制度前后。
在 15 周内，住院医师每周完成一次调查，包括 Epworth 嗜睡量表（ESS）。该服务在 3 周后改为夜间轮班制度（即，先连续 3-4 天，然后连续 6 天）。
ESS 评分从 9.8 ± 5.2 分别升高到 14.9 ± 3.1 和 14.4 ± 4.5（P =.042），在 3/4 和 6/1 轮班制度下。在任何一种夜间轮班制度下，住院医师都更容易感到异常疲劳（相对风险=2.86；95%置信区间，1.17-6.97，P =.029）。
新的 ACGME 工作时间增加了 NWH 住院医师的 ESS 评分，并导致住院医师比 Q4 值班的住院医师更疲劳。这可能是由于连续多晚睡眠不足，没有补觉的轮班后一天造成的。
