ACGME Duty Hour Revisions and Self-Reported Intern ICU Sleep Schedules

The Accreditation Council for Graduate Medical Education duty hour standards restrict continuous duty for postgraduate year (PGY)-1 residents to 16 hours.

We aimed to assess the relationship between a duty hour-compliant schedule and resident sleep.

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.

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).

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.