Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff: A Randomized Trial

摘要: Importance On July 1, 2011, the Accreditation Council for Graduate Medical Education implemented further restrictions of its 2003 regulations on duty hours and supervision. It remains unclear if improved trainee well-being or patient safety. Objective To determine effects 2011 hour compared with concerning sleep duration, education, continuity care, perceived quality care among internal medicine trainees. Design Setting Crossover study design in an academic research setting. Participants house staff. Intervention General medical teams were randomly assigned using a sealed-envelope draw to experimental model control model. Main Outcome Measures We 4 staff (43 interns) 3-month crossover 2003-compliant every fourth night overnight call (control) 30-hour limits one two 2011-compliant models fifth (Q5) float schedule (NF), both 16-hour limits. measured duration actigraphy used admission volumes, educational opportunities, number handoffs, satisfaction surveys assess care. Results The included 560 control, 420 Q5, 140 NF days that interns worked 834 hospital admissions. Compared controls, slept longer during period (mean, 5.1 vs 8.3 hours; P = .003), Q5 postcall 7.5 10.2 P = .05). However, increased decreased availability teaching conferences, reduced intern presence daytime work hours. Residents nurses so much it was terminated early. Conclusions Relevance model, regulation–compliant associated on-call deteriorations