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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety.
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Effects of the accreditation council for graduate medical education duty hour limits on sleep, work hours, and safety.

机译：研究生医学教育工作时间限制认证委员会对睡眠，工作时间和安全性的影响。

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OBJECTIVE: To mitigate the risks of fatigue-related medical errors, the Accreditation Council for Graduate Medical Education introduced work hour limits for resident physicians in 2003. Our goal was to determine whether work hours, sleep, and safety changed after implementation of the Accreditation Council for Graduate Medical Education standards. METHODS: We conducted a prospective cohort study in which residents from 3 large pediatric training programs provided daily reports of work hours and sleep. In addition, they completed reports of near-miss and actual motor vehicle crashes, occupational exposures, self-reported medical errors, and ratings of educational experience. They were screened for depression and burnout. Concurrently, at 2 of the centers, data on medication errors were collected prospectively by using an established active surveillance method. RESULTS: A total of 220 residents provided 6007 daily reports of their work hours and sleep, and 16 158 medication orders were reviewed. Althoughscheduling changes were made in each program to accommodate the standards, 24- to 30-hour shifts remained common, and the frequency of residents' call remained largely unchanged. There was no change in residents' measured total work hours or sleep hours. There was no change in the overall rate of medication errors, and there was a borderline increase in the rate of resident physician ordering errors, from 1.06 to 1.38 errors per 100 patient-days. Rates of motor vehicle crashes, occupational exposures, depression, and self-reported medical errors and overall ratings of work and educational experiences did not change. The mean length of extended-duration (on-call) shifts decreased 2.7% to 28.5 hours, and rates of resident burnout decreased significantly (from 75.4% to 57.0%). CONCLUSIONS: Total hours of work and sleep did not change after implementation of the duty hour standards. Although fewer residents were burned out, rates of medication errors, resident depression, and resident injuries and educational ratings did not improve.
机译：目的：为减轻与疲劳相关的医疗错误的风险，研究生医学教育认证委员会于2003年引入了住院医师工作时间限制。我们的目标是确定实施认证委员会后工作时间，睡眠和安全性是否发生了变化研究生医学教育标准。方法：我们进行了一项前瞻性队列研究，其中来自3个大型儿科培训计划的居民每天提供工作时间和睡眠报告。此外，他们还完成了关于未遂事故和实际机动车碰撞，职业暴露，自我报告的医疗失误以及教育经历评估的报告。对他们进行了抑郁和倦怠筛查。同时，在两个中心中，使用建立的主动监视方法前瞻性地收集了有关药物错误的数据。结果：共有220位居民提供了6007份关于他们的工作时间和睡眠的每日报告，并审查了16158份用药处方。尽管在每个程序中都进行了计划更改以适应标准，但轮班通常要24到30小时，而且居民拨打电话的频率基本上保持不变。居民的总工作时间或睡眠时间没有变化。药物错误的总体发生率没有变化，住院医师订购错误的发生率从每100个患者日的1.06错误增加到1.38错误。机动车碰撞，职业暴露，抑郁和自我报告的医疗错误的发生率以及工作和教育经历的总体评价没有改变。持续时间（通话）的平均时长减少了2.7％，降至28.5小时，居民的倦怠率显着降低（从75.4％降至57.0％）。结论：执行工作时间标准后，总的工作和睡眠时间没有改变。尽管精疲力竭的居民减少了，但用药错误，居民抑郁，居民受伤和教育程度的改善却没有改善。

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