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. 2004. 351(18):1829-37
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% CI
P value
ESS≥10
1.34
1.10-1.64
0.019
Depression
1.39
1.11-1.74
0.005
Self
Reported
Errors
1.46
0.91-2.35
0.074
Results: Work Hours Schedule
Factor
RR of ACGME
complaint v.
Q4
95% CI
P value
ESS≥10
2.86
1.17-6.97
0.029
Depression
0.24
0.1-1.4
0.093
Work>80hrs
1.37
0.46-4.14
0.561
Results-Work Hours Schedule
ESS scores
14.6±3.8
P=0.01
16
14
9.4±5.4
12
10
8
6
4
2
0
Surgery (Q4)
Surgery (ACGME
Compliant)
*
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 ACGMEcompliant 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 tiredthis 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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