Factors Associated with Intern Fatigue

Abstract

BACKGROUND: Prior data suggest that fatigue adversely affects patient safety and resident well-being. ACGME duty hour limitations were intended, in part, to reduce resident fatigue, but the factors that affect intern fatigue are unknown. OBJECTIVE:To identify factors associated with intern fatigue following implementation of duty hour limitations. DESIGN:Cross-sectional confidential survey of validated questions related to fatigue, sleep, and stress, as well as author-developed teamwork questions.SUBJECTS: Interns in cognitive specialties at the University of California, San Francisco. MEASUREMENTS:Univariate statistics characterized the distribution of responses. Pearson correlations elucidated bivariate relationships between fatigue and other variables. Multivariate linear regression models identified factors independently associated with fatigue, sleep, and stress. RESULTS:Of 111 eligible interns, 66 responded (59%). In a regression analysis including gender, hours worked in the previous week, sleep quality, perceived stress, and teamwork, only poorer quality of sleep and greater perceived stress were significantly associated with fatigue (p<0.001 and p=0.02, respectively). To identify factors that may affect sleep, specifically duty hours and stress, a secondary model was constructed. Only greater perceived stress was significantly associated with diminished sleep quality (p=0.04), and only poorer teamwork was significantly associated with perceived stress (p<0.001). Working >80 h was not significantly associated with perceived stress, quality of sleep, or fatigue. CONCLUSIONS:Simply decreasing the number of duty hours may be insufficient to reduce intern fatigue. Residency programs may need to incorporate programmatic changes to reduce stress, improve sleep quality, and foster teamwork in order to decrease intern fatigue and its deleterious consequences.

Fatigue-related risk management in the emergency department: a focus-group study

“…The literature supports physicians' perceived effects of fatigue on productivity [18], situation awareness [19], patient-centred communications [20] and teamwork [21]. Extended periods of time in the ED have been demonstrated to be strongly, negatively connected to physicians' patientsper-hour rate [18].…”

Limiting PGY 1 Residents to 16 Hours of Duty: Review and Report of a Workshop

“…However, reports suggest that the 2003 work-hour rules did not increase residents' hours of sleep or reduce fatigue. 8 In addition, studies using national data samples did not show evidence of improved patient safety after the 2003 work-hour rules were put into effect. It seems that simply decreasing the number of duty hours does not guarantee reduced resident fatigue.…”

Implementation of 2011 Duty Hours Regulations through a Workload Reduction Strategy and Impact on Residency Training

“…1 The new guidelines reiterated the 2003 recommendations (maximum of 80 h of work per week and direct patient care shifts no longer than 24 + 4 h) and restricted post-graduate year 1 (PGY-1) trainees to a maximum shift length of 16 h, with a minimum of 8 h off between shifts. 2,3 Studies of 2011 models, similar to outcomes following 2003 changes, [4][5][6][7][8] have yet to show any improvements in quality of care, 9-12 trainee education, 11 or resident well-being. 13 Also, program director and resident surveys have conveyed strong concerns about sacrificing continuity of care and educational activities for DHR compliance.…”