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Objective: To examine changes in resident sleep hours, duty hour violations, and cognitive function after implementation of new ACGME work hour restrictions.
Design: Non-randomized intervention
Setting: A general surgery residency program
Participants: All general surgery residents (PGY1-5) (N=21)
Intervention: Implementation of new ACGME duty hour guidelines 6 months before required. All residents were restricted to 16-hour shifts.
Main Outcome Measure: Outcomes assessed included average sleep hours, number of duty hour violations, and executive function and verbal memory.
Results: Residents were more likely to violate the 80-hour workweek (3 vs. 1 violations) and the 24-hour shift restrictions (4 vs. 0 violations) before the new guidelines were adopted; however, the number of 10-hours-off violations increased from 23 to 51. The number of residents scheduled to work during normal sleeping hours was reduced from 12 to 4 per week. Reported sleep hours were relatively unchanged (median 6.37 vs. 6.52 hours), but the percentage of nights with sleep greater than 6 hours increased (78% vs. 93%). There was no difference in cognitive functioning.
Conclusions: The implementation of new ACGME guidelines within a surgical residency program appeared to decrease sleep deprivation and minimize instances of circadian misalignment. Although we did not observe an improvement in cognitive functioning, decreased resident fatigue may reduce resident errors and improve patient safety.