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Previous Volume 352:125-134 January 13, 2005 Number 2 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Wylie, C. D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Long work hours and work shifts of an extended duration (24 hours) remain a hallmark of medical education in the United States. Yet their effect on health and safety has not been evaluated with the use of validated measures.

Methods We conducted a prospective nationwide, Web-based survey in which 2737 residents in their first postgraduate year (interns) completed 17,003 monthly reports that provided detailed information about work hours, work shifts of an extended duration, documented motor vehicle crashes, near-miss incidents, and incidents involving involuntary sleeping.

Results The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively. In a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly risk of a crash during the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in which interns worked five or more extended shifts, the risk that they would fall asleep while driving or while stopped in traffic was significantly increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46] and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively).

Conclusions Extended-duration work shifts, which are currently sanctioned by the Accreditation Council for Graduate Medical Education, pose safety hazards for interns. These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.

Source Information

From the Division of Sleep Medicine (L.K.B., B.E.C., N.T.A., J.W.C., C.A.C.) and the Channing Laboratory (B.R., F.E.S.), Department of Medicine, Brigham and Women's Hospital; and the Division of Sleep Medicine, Harvard Medical School (L.K.B., N.T.A., J.W.C., C.A.C.) — both in Boston; and the Department of Medicine, University of British Columbia; and the Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute — both in Vancouver, B.C., Canada (N.T.A.).

Address reprint requests to Dr. Czeisler at the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave., Boston, MA 02115, or at caczeisler{at}hms.harvard.edu.

Full Text of this Article

Related Letters:

Post-Call Accidents
Halpern S. D., Borden W., Kamp R., Hunt K. E., Wallach R. C., Barger L. K., Ayas N., Czeisler C. A., the Harvard Work Hours, Health, and Safety Group
Extract | Full Text | PDF  
N Engl J Med 2005; 352:1491-1492, Apr 7, 2005. Correspondence

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