ACGME Duty Hour Revisions and Self-Reported Intern ICU Sleep Schedules
Abstract Background The Accreditation Council for Graduate Medical Education duty hour standards restrict continuous duty for postgraduate year (PGY)–1 residents to 16 hours. Objective We aimed to assess the relationship between a duty hour–compliant schedule and resident sleep. Methods To comply with 2011 duty hour limits, Beth Israel Deaconess Medical Center restructured its intensive care unit call model for internal medicine PGY-1 residents from a traditional shift model to an overlapping shorter-duration shift model with preserved educational periods. Before and after schedule changes, we used daily surveys of PGY-1 residents to collect self-reported data on quantity and quality of sleep and quality of education. Results A total of 1162 surveys were sent to 43 interns before scheduling changes, and 1305 were sent to 41 interns after the changes. Response rate was 31.2% (362 of 1161) before and 22.2% (290 of 1305) after. Before changes, 57.7% (209 of 362) reported receiving 6 hours or more of sleep in a 24-hour period compared to 72.4% (210 of 290) after the changes (adjusted relative risk, 1.33; 95% CI, 1.15–1.53), with an adjusted difference of 0.83 hours of sleep per 24 hours (95% CI, 0.28–1.38). After the intervention, on a 5-point Likert scale, residents reported higher quality of sleep (odds ratio [OR], 1.62; 95% CI, 1.01–2.60) and greater satisfaction with their education (OR, 2.59; 95% CI, 1.40–4.81). Conclusions Following conversion to a duty hour–compliant model with preserved didactic time, PGY-1 residents reported minor increases in quantity and quality of sleep per 24-hour period, and increased satisfaction with the educational experience.