Department of Neonatology, Montreal Children's Hospital, Montréal, Québec, Canada.
Department of Pediatrics, CHU de Québec, Québec, Canada.
Am J Perinatol. 2018 Jul;35(9):911-918. doi: 10.1055/s-0038-1627442. Epub 2018 Feb 8.
This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU.
This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU ( = 185) and infants admitted to the NICU ( = 8,159). Adjusted odds ratios (aOR) were estimated for mortality with respect to Epoch (2008-2011 [24-hour shifts] versus 2011-2014 [16-hour shifts]), level of trainee, and the number of residents present at admission.
The reduction in maximum consecutive hours worked was associated with a significant reduction of the median yearly total hours worked per resident in the NICU (381 hour vs. 276 hour, < 0.01). Early mortality rate was 1.2% (50/4,107) before the resident duty hour reform and 0.8% (33/4,052) after the reform (aOR, 0.57; 95% confidence interval [CI], 0.33-0.98). Neither level of trainee (aOR, 1.22; 95% CI, 0.71-2.10; junior vs. senior) nor the number of residents present at admission (aOR, 2.08; 95% CI, 0.43-10.02, 5-8 residents vs. 0-2 residents) were associated with early mortality. Resident duty hour reform was not associated with hospital mortality (aOR, 0.73; 95% CI, 0.50-1.07; after vs. before resident duty hour reform).
Resident duty hour restrictions were associated with a reduction in the number of yearly hours worked by residents in the NICU as well as a significant decrease in adjusted odds of early mortality but not of hospital mortality in admitted neonates.
本文评估了将住院医师连续工作时间从 24 小时减少到 16 小时对新生儿重症监护病房（NICU）中每名住院医师每年总工作时间的影响，并评估了住院医师轮班制改革、受训人员水平和入院时住院医师人数与 NICU 死亡率之间的关联。
这是一项回顾性队列研究，共纳入在三级 NICU 工作的所有儿科住院医师（ = 185 人）和入住 NICU 的婴儿（ = 8159 人）。根据时代（2008-2011 年[24 小时轮班]与 2011-2014 年[16 小时轮班]）、受训人员水平和入院时住院医师人数，对死亡率进行调整后优势比（aOR）估计。
最大连续工作时间的减少与 NICU 每名住院医师每年总工作时间中位数的显著减少相关（381 小时比 276 小时， < 0.01）。轮班制改革前的早期死亡率为 1.2%（50/4107），改革后为 0.8%（33/4052）（aOR，0.57；95%置信区间[CI]，0.33-0.98）。受训人员水平（aOR，1.22；95%CI，0.71-2.10；初级 vs. 高级）和入院时住院医师人数（aOR，2.08；95%CI，0.43-10.02；5-8 名住院医师 vs. 0-2 名住院医师）均与早期死亡率无关。住院医师轮班制改革与院内死亡率无关（aOR，0.73；95%CI，0.50-1.07；改革后 vs. 改革前）。
住院医师轮班时间限制与 NICU 住院医师每年工作时间减少以及调整后早期死亡率的显著降低相关，但与入院新生儿的院内死亡率无关。
