The Effect of New ACGME Work Hour Rules on Resident Exhaustion: Prospective Study in a Community Teaching Hospital Tovy Haber Kamine, MD John D. Galbraith, MD Frederick Millham, MD Janet Larson, MD

Background: The New Work Hours A 16 hour schedule decreased attention failures and increased wakefulness over a q3 schedule. Interns started new ACGME work hours: July, 2011 ▫80 hours per week ▫No more than 16 hours straight per shift Lockley et al., Effect of Reducing Interns’ Weekly Work Hours on Sleep and Attentional Failures. NEJM (18):

Background: Nightfloat Risks Decrease in education ▫Deterioration in laparoscopic skills ▫Decreased perception of quality of education Increased sleepiness ▫Increased risk of car accidents Hormonal abnormalities ▫Increased risk of metabolic syndrome ▫Increased risk of stroke ▫Increased risk of breast cancer ▫Decreased mood

Methods: Surveys NWH Transitional Year Interns and rotating MGH Anesthesia, Medicine, Psychiatry and Surgery interns filled out surveys From 2/9/2011 until 5/20/2011, interns on the Surgical, Medical, and MICU services filled out weekly surveys including: ▫demographic data ▫Questions from the Beck Depression Inventory ▫Epworth Sleepiness Scale The Surgical service switched to an ACGME compliant on 3/3/2011

Methods: Statistical Analysis Data dichotomized for analysis ▫ESS scores dichotomized to <10 or 10+ ▫Hours dichotomized to <80, 80+ ▫Days of depression and self-reported error data dichotomized to 0 or 1+ in the past week ▫All other data dichotomized about the median Comparison of absolute ESS scores performed using an unpaired T-Test All other comparisons and relative risks calculated using a chi square test Surgical data were used to evaluate the effects of workhours change All data (including medicine data) were used to evaluate the effects of working >80 hours

Results: Surveys 97 total surveys filled out by 44 interns over the study period 30 surveys were filled out by 14 interns on the surgical service

Results-Effects of Working >80 hours per week Factor RR of working >80 hours in the previous week 95% CIP value ESS≥ Depression Self Reported Errors

Results: Work Hours Schedule Factor RR of ACGME complaint v. Q4 95% CIP value ESS≥ Depression Work>80hrs

Results-Work Hours Schedule P=0.01 *

Discussion-Hours Interns working >80 hours were more tired than those working <80 hours ▫In addition, they reported more depression and trended to more self-reported errors This is consistent with Lockley, et al 2004, where “intervention group” residents averaged 65 hours compared to 85 hours in the Q3 call group All interns in this cohort abided by the ACGME rules, i.e. they did not work more than 80 hours per week, averaged over 4 weeks ▫However, these data suggest that residents should not work more than 80 hours in any week.

Discussion-Work Hours Schedule Interns on the AGCME-compliant work hours schedule were significantly more tired than those on a Q4 schedule. Residents' average ESS on the ACGME- compliant schedule was identical to previously published data from before the 80 hour work week was implemented

Discussion-Work Hours Schedule Increased sleepiness may be due to: ▫Lack of a post-call day to recuperate from decreased sleep ▫Up to 12 days accumulation of sleep debt, rather than 4 Previous data have correlated ESS scores with medical errors. Our data did not show increased self-reported medical errors in the ACGME compliant group, though they were more tired- this may be due to insignificant power of our study to detect this. More study is needed on the real world effects of the new ACGME work hours

Conclusions The new ACGME work hours cause interns to be as tired as they were before implementation of the 80-hour work week ▫The schedule of work may be more important than the total number of hours worked Interns who work more than 80 hours in a week are more tired, more likely to be depressed, and trend to more self-reported errors

Acknowledgements Marie Williams Rebecca Barron, MD, MPH Agnes Lesicka, MD Interns of NWH

Questions?

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