Resident Fatigue Before and After ACGME Duty Hour Limits

William L Cull, PhD¹, Holly J Mulvey, MA ² and Ethan A B Jewett, MA ². ¹ Department of Practice and Research, AAP, Elk Grove Village, IL, United States, 60007 and ² Department of Education, AAP, Elk Grove Village, IL, United States, 60007.

 

Background: Concern about resident fatigue and patient safety led the Accreditation Council for Graduate Medical Education (ACGME) to institute limits on resident duty hours, effective on July 1, 2003.

 

Objective: To assess the impact of duty-hour limits by comparing the experiences of residents graduating before and after the implementation of the ACGME duty hours limits in pediatric residencies.

 

Design/Methods: As part of the AAP Graduating Resident Survey, 500 categorical pediatrics residents graduating in 2002 and in 2004 were asked about duty hours, fatigue, moonlighting, and federal regulation of duty hours. Multivariate analyses were conducted to compare reported differences between the 2002 and 2004 groups while controlling for resident characteristics.

 

Results: Of the 500 residents surveyed each year, 323 (65%) and 302 (60%) responded in 2002 and 2004, respectively. The percentage of residents who reported working on average greater than 80 hours per week was reduced for ward (33% to 15%, p < .001) and for NICU/PICU (49% to 18%, p < .001) rotations. While controlling for resident characteristics including moonlighting activity, fewer residents reported that fatigue from work in the past year caused them to fall asleep during an educational conference (OR = .78, p = .018), to fall asleep while driving (OR = .75, p = .003), or to make an error in patient care (OR = .68, p = .004). In 2004, more residents reported that they think the system is effective in ensuring appropriate working hours for pediatric residents (46% in 2002 and 87% in 2004, p < .001). Despite these reported improvements, most residents still felt that federal law should regulate resident work hours (80% in 2002 and 78% in 2004, p = .51)

 

Conclusions: Based on resident self-report, ACGME limits have successfully reduced resident duty hours and adverse outcomes associated with resident fatigue, including residents falling asleep while driving and committing errors in patient care. Still, many residents report working greater than 80 hours per week in some rotations, and most believe federal law should regulate resident work hours.