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在工作地居住还是在居住地工作?“居家值班”时住院医师的工作与睡眠模式

Work Where You Live or Live Where You Work? Resident Work and Sleep Patterns While on "Home Call".

作者信息

Mitchell David T, Koppin Noa G, Talanker Michael T, Bhadkamkar Mohin A, Marques Erik S, Greives Matthew R, Hopkins David C

机构信息

From the Department of Surgery, Division of Plastic Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Tex.

出版信息

Plast Reconstr Surg Glob Open. 2024 Sep 13;12(9):e6191. doi: 10.1097/GOX.0000000000006191. eCollection 2024 Sep.

Abstract

BACKGROUND

Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for "home call" shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

METHODS

A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States. Data include number of trips into the hospital, hours spent in the hospital, and hours of sleep.

RESULTS

Response rate was 195 of 200 (97.5%) total call shifts from 7 pm to 7 am the next morning. Junior residents reported an average of 3.25, 3.92, and 0.73 hours of sleep when on hand call, face call, and triple call (hand + face + general), respectively. Senior residents reported an average of 4.18 and 4.75 hours of sleep for hand and face call, respectively.

CONCLUSIONS

Hours of sleep when taking home call varies widely based on type of call. Junior residents reported significantly decreased sleep and more time in the hospital when taking hand, face, and triple call compared with general call alone. Senior residents reported that both hand and face call result in significantly decreased hours of sleep compared with general call alone. These results highlight the need to discuss ACGME protection for residents taking home call.

摘要

背景

与院内值班不同,毕业后医学教育认证委员会(ACGME)并不要求为“居家值班”轮班安排值班后休息一天。尽管如此,我们推测,尽管有居家值班的便利,但值班住院医师在轮班的大部分时间仍在医院,因此不受ACGME值班后工作时长规定的保护。

方法

通过对2023年1月至2023年4月在美国最繁忙的一级创伤中心之一完成夜间值班轮班的初级和高级住院医师进行调查,开展了一项前瞻性单中心调查研究。数据包括进入医院的次数、在医院花费的时间以及睡眠时间。

结果

在总共200次从晚上7点到次日早上7点的值班轮班中,回复率为195次(97.5%)。初级住院医师报告称,在手值班、面对面值班和三重值班(手 + 面对面 + 普通)时,平均睡眠时间分别为3.25小时、3.92小时和0.73小时。高级住院医师报告称,在手值班和面对面值班时,平均睡眠时间分别为4.18小时和4.75小时。

结论

居家值班时的睡眠时间因值班类型而异。与仅进行普通值班相比,初级住院医师报告称在手值班、面对面值班和三重值班时睡眠时间显著减少,且在医院的时间更多。高级住院医师报告称,与仅进行普通值班相比,手值班和面对面值班都会导致睡眠时间显著减少。这些结果凸显了讨论ACGME对居家值班住院医师保护措施的必要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/efe8/11398784/8c8b68272518/gox-12-e6191-g001.jpg

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