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Extended work shifts and the risk of motor vehicle crashes among interns.

Authors
Barger-LK; Cade-BE; Ayas-NT; Cronin-JW; Rosner-B; Speizer-FE; Czeisler-CA
Source
N Engl J Med 2005 Jan; 352(2):125-134
NIOSHTIC No.
20025824
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.
Keywords
Shift-work; Shift-workers; Health-care-personnel; Accident-rates; Accident-statistics; Accident-potential; Motor-vehicles; Statistical-analysis; Surveillance-programs; Medical-personnel; Sleep-deprivation
Contact
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
CODEN
NEJMAG
Publication Date
20050113
Document Type
Journal Article
Email Address
caczeisler@hms.harvard.edu
Funding Type
Grant
Fiscal Year
2005
NTIS Accession No.
NTIS Price
Identifying No.
Grant-Number-R01-OH-007567
Issue of Publication
2
ISSN
0028-4793
Source Name
New England Journal of Medicine
State
MA
Performing Organization
Brigham and Women's Hospital
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