JAMA Study Finds Pervasive Work-Hour Violations

Though overall average hours worked by residents decreased and sleep time increased slightly after implementation of the ACGME duty-hour rules, violations of the rules were pervasive across programs and services, according to a report in the September 6 Journal of the American Medical Association.

The survey was a prospective cohort study using a monthly Web-based survey assessment of intern work and sleep hours prior to implementation of ACGME duty hour rules (July 2002 through May 2003) and after implementation (July 2003 through May 2004). A total of 4,015 interns in U.S. residency programs in all specialties completed 29,477 anonymous reports of work and sleep hours in the study's two phases.

The study found that after implementation, 1,068 interns reported work hours in violation of the standards during one or more months. Working shifts greater than 30 consecutive hours was reported by 67.4 percent of interns.

Averaged over four weeks, 43 percent of respondents reported working more than 80 hours weekly, and 43.7 percent reported not having one day in seven off work duties.

Comparing pre- and post-implementation, reported mean work duration decreased from 70.7 hours to 66.6 hours a week. Reported mean sleep duration increased from 5.91 hours to 6.27 hours a night.

“We were shocked that people were not complying with these [rules] at all and at how frequent the violations occurred,” said study author Christopher Landrigan, M.D. “The concern is less that there is a person here and there over the limit, but that in general these absolute limits are not seen as absolute. People are doing what they have always done.”