Overworked interns risk car crashes
First-year doctors in training, or medical interns, who work shifts of longer than 24 hours are more than twice as likely to have a car crash leaving the hospital and five times as likely to have a "near miss" incident on the road as medical interns who work shorter shifts, according to an article in the Jan. 13 issue of the New England Journal of Medicine (NEJM).
The article, "Extended work shifts and the risk of motor vehicle crashes among interns," is the third in a series of studies on the impact of extended work hours and fatigue on interns conducted by the Divisions of Sleep Medicine at the Brigham and Women’s Hospital and the Harvard Medical School in Boston.
The first two studies were published in the Oct. 28, 2004, issue of NEJM. All three were co-funded by the Agency for Healthcare Research and Quality and the National Institute for Occupational Safety and Health.
Laura K. Barger, PhD, research associate in medicine at the Brigham and Women’s Hospital and Harvard Medical School, and her colleagues recruited 2,737 interns from medical institutions around the country to fill out detailed monthly surveys recording their work hours, frequency of shifts of more than 24 hours, and driving safety records, including car accidents, near-miss incidents in which property damage was narrowly avoided, and incidents involving falling asleep while driving or while stopped in traffic.
More than 17,000 surveys were collected between April 2002 and May 2003. Researchers also randomly selected 7% of study participants to keep daily work diaries that were verified through direct observation.
The study found that the majority of interns routinely worked more than 30 consecutive hours, and they reported that they were awake 96% of their time in the hospital on average.
Also, during the 12-month study period, interns reported working an average of 80 hours or more during 46% of work weeks and 100 hours or more per week during 11% of work weeks.
Study participants reported a total of 320 accidents during the 12-month study period, including 133 that resulted in treatment in the emergency department, property damage of more than $1,000, or the filing of a police report.
Slightly more than 40% of the 320 crashes occurred on the commute from work. Every extended shift that was scheduled per month increased the monthly rate of accidents on the commute from work by 16% and the monthly rate of any car accident by 9%.
Interns also were more than twice as likely to fall asleep while driving or more than three times as likely to fall asleep while stopped in traffic
in months in which they worked five or more extended shifts.
Minnesota Medicaid applies NCQA standards
Health plans in the state of Minnesota accredited by the National Committee for Quality Assurance (NCQA) will gain a new benefit under an agreement reached by the state and NCQA: The Minnesota Department of Human Services, the state’s Medicaid agency, will apply NCQA accreditation standards to five major areas of the department’s annual quality review required under federal law.
Standards will be applied where they are consistent with federal and state managed care contract requirements in the areas of credentialing, utilization management, grievances, quality improvement and delegation.
This determination will reduce an NCQA-accredited health plan’s overall oversight burden.
For more information about federal or state recognition or to inquire about the NCQA accreditation process, contact Patricia Pergal, director of public policy, at (202) 955-3595. A complete listing of states that recognize NCQA accreditation is available at www.ncqa.org.