SLEEP 2011 Abstract Supplement

B. Clinical Sleep Science XV. Healthcare Services, Research and Education
0978
IMPACT OF EXTENDED-DURATION SHIFTS ON MOTOR
VEHICLE CRASHES, MEDICAL ERRORS AND ADVERSE
EVENTS IN PGY 2-7 RESIDENT PHYSICIANS
Barger L 1,2 , Abaluck BK 1,2 , Abaluck JT 3 , Landrigan CP 1,2,4 ,
Czeisler CA 1,2
1
Medicine, Brigham and Women’s Hospital, Boston, MA, USA,
2
Division of Sleep Medicine, Harvard Medical School, Boston,
MA, USA, 3 Department of Economics, Massachusetts Institute of
Technology, Cambridge, MA, USA, 4 Department of Pediatrics,
Children’s Hospital of Boston, Boston, MA, USA
Introduction: The Harvard Work Hours, Health and Safety Group has
established that extended-duration (greater than or equal to 24 hours)
work shifts, which have been a hallmark of medical education, are associated
with higher risks of motor vehicle crashes, medical errors and
adverse events among resident physicians in postgraduate year one
(PGY-1). Here we report these safety outcomes in resident physicians in
postgraduate years 2-7 (PGY 2-7).
Methods: We conducted a nationwide web-based survey over 5 years
and gathered 13,737 person-months of data from PGY 2-7 resident physicians.
94% of these data were collected following the introduction of
work-hour guidelines established by the Accreditation Council for Graduate
Medical Education (ACGME) in July, 2003.
Results: In 46% of person-months, PGY 2-7 physicians reported their
longest work shift was greater than or equal to 24 hours. The risk of a
reported motor vehicle crash and near-miss incident was significantly
increased after an extended duration work shift as compared with a
shift that was not of extended duration (OR: 1.72; 95% CI: 1.01-2.90
and OR: 5.13; 95% CI: 4.40-5.96, respectively). The risk of reporting a
fatigue-related error was significantly increased in months including 1-4
extended shifts (OR: 1.77, 95% CI: 1.27-2.47) or 5 or more extended
shifts (OR: 5.2; 95% CI: 3.79-7.1), as compared to months including
no extended shifts. Risk of reporting a fatigue-related adverse events in
which a patient was injured was significantly increased in months including
1-4 extended shifts (OR: 2.53; 95% CI: 1.02-6.25) or 5 or more
extended shifts (OR: 3.36; 95% CI: 1.52-7.41), as compared to months
including no extended shifts.
Conclusion: Extended duration work shifts are a major risk factor for
PGY 2-7 resident physicians and their patients. These data suggest that
the ACGME should consider extending its recently-announced 16-hour
work-hour limit for PGY1 resident physicians to PGY2-7 resident physicians
as well.
0979
THEORY OF PLANNED BEHAVIOR AS A PREDICTOR OF
SLEEP HYGIENE AND SLEEP QUALITY
von Linden MI 1,2 , Powell ED 3 , Muehlbach MJ 3 , Ojile JM 3
1
Department of Psychology, Saint Louis University, St. Louis, MO,
USA, 2 Carl T Hayden VA Medical Center, Phoenix, AZ, USA, 3 Clayton
Sleep Institute, St. Louis, MO, USA
Introduction: The theory of planned behavior (TPB) suggests the importance
of three independent considerations: attitude or value regarding
the importance of sleep, perceptions of subjective norms or social
support, and perceived behavioral control or self-efficacy. These considerations
may be factors related to sleep hygiene behaviors and sleep
quality. The objective of the present study was to examine associations
among sleep hygiene and quality with public attitudes regarding the importance
of sleep, perceived social support, and levels of health selfefficacy.
Methods: Men and women primarily from a Midwest metropolitan area
and between the ages of 18-65 years completed an online survey. The
survey included demographics, sleep hygiene (SH) measure, Pittsburgh
Sleep Quality Index (PSQI), Health Associations Scale (HAS), Value
on Health Scale (VHS), Social Support Scale, and the Perceived Health
Competence Scale (PHCS). The HAS assesses health attitude by associating
health indicators with outcomes. Measures related to the components
of TPB were regressed on sleep hygiene and quality measures.
Results: A total of 232 surveys were completed. Of the eight health indicators
on the HAS, poor sleep was on average the fourth most significant
(rank 1-8, mean rank = 4.26), behind stress, diet, and exercise. The
health outcome of insomnia ranked sixth of nine outcomes (rank 1-9,
mean rank = 6.15), suggesting poor sleep does not rank high according
to personal importance of health outcomes. Using a stepwise regression,
the VHS (F= 21.25, p< .001), the PHCS (F= 15.08, p< .001), and the
HAS Sleep item (F= 11.74, p< .001) all entered the model to predict
sleep hygiene and accounted for 14% of the variance. For sleep quality,
only the PHCS entered the model (F= 18.83, p< .001) and accounted for
8% of the variance.
Conclusion: As measured by the HAS, attitudes about health indicators
and outcomes generally undervalue sleep as a leading cause of negative
health outcomes. Lower value placed on one’s health and lower health
competency are predictive factors of poor sleep behaviors. Whereas individuals
with higher perceived health competence predict better sleep
quality. Applying the TPB may be a useful tool in designing interventions
to promote better sleep habits and quality.
0980
AN INTERNET BASED EDUCATION PROGRAM IMPROVES
SLEEP LITERACY IN COLLEGE PSYCHOLOGY STUDENTS
Quan SF 1,2 , Anderson JL 1,2,3 , Hodge GK 3
1
Division of Sleep Medicine, Harvard Medical School, Boston, MA,
USA, 2 Sleep Medicine, Brigham and Women’s Hospital, Boston, MA,
USA, 3 Psychology, University of New Mexico, Albuquerque, NM,
USA
Introduction: Knowledge regarding the importance of sleep in health
and performance, and good sleep hygiene practices is low, especially
among adolescents and young adults. Introductory psychology is one of
the most highly enrolled courses at colleges and universities. This study
tested the impact of an internet-based learning module on improving
sleep literacy in this venue.
Methods: An internet-based learning module containing sleep physiology
and hygiene information was developed using content from the
Harvard Medical School sleep educational website http://www.understandingsleep.org.
Access to the module was provided as an extra credit
activity for 2 of 4 sections (Experimental, N=889) of an introductory
college psychology course during their standard instruction on sleep and
dreaming. The remaining 2 sections (Control, N=878) were encouraged
to visit only the website. Level of knowledge was assessed before and
after access to the module or website, and just before the final examination.
Results: 354 in the Experimental and 253 in the Control groups participated
in the extra credit activity. Pretesting showed equivalency in sleep
knowledge between the 2 groups (Experimental: 17.7 +/- 3.9 [sd]; Control:
18.1 +/- 3.1, p=ns). At the end of standard instruction, the Experimental
group improved their sleep knowledge while the Control group’s
scores did not change (23.9 +/- 4.3 vs. 18.4 +/- 3.9, p