David Fisman, MD, MPH, Epidemiology and Biostatistics, Drexel School of Public Health, 245 N. 15th Street, Mail Stop 660, Philadelphia, PA 19102-1192, 215-762-3934, DF62@drexel.edu, Anthony D Harris, MD, MPH, Department of Epidemiology and Preventve Medicine, University of Maryland, Baltimore, School of Medicine, 10 N. Greene St., Medical Service Rm 5D-151, Baltimore, MD 21201, Gary S. Sorock, PhD, Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, 624 N. Broadway, Room 545, Baltimore, MD 21205, Michael Rubin, MD, Department of Clinical Epidemiology, University of Utah, 30 N 1900 E, SOM AC263, Salt Lake City, UT 84132, and Murray A. Mittleman, MD, DrPH, Epidemiology, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115.

Background: Concern that extreme fatigue among medical trainees compromises patient safety has resulted in regulatory efforts aimed at limiting the duration of trainee work days. The question of whether fatigue could also compromise the safety of trainees themselves has not been evaluated. Methods: We interviewed 250 healthcare workers who sustained sharps-related injuries over a 3-year period. Incidence rate ratios for injury in association with fatigue were calculated using a case-crossover design with a “usual frequency” approach, which controls for confounders that remain constant over time. Results: Eighty-two (33%) of interviewed subjects were medical trainees. Trainees had worked more hours per week (median hours 70 vs. 40, P<0.001) and been at work longer on the day of injury (median 6.5 hours vs. 5 hours, P=0.006) than other healthcare workers. Fatigue was more common at the time of injury in medical trainees (RR 1.7 95% CI 1.1-2.5). While fatigue was associated with an increase in injury risk in the study population as a whole (incidence rate ratio (IRR) 1.4, 95% CI 1.0-2.0), stratified analyses found this association to be stronger in medical trainees (IRR 3.0, 95% CI 1.6-5.7), and to be absent in other healthcare workers (IRR 1.0, 95% CI 0.7-1.5) (P <0.001 by Wald test). Conclusions: Working hours are longer in medical trainees than in other healthcare workers, and are associated with increased injury risk. Reduction of risk in trainees through modification of work hours and practices is an important potential benefit of efforts to restructure medical training in North America.

Learning Objectives:

• Participants will gain an understanding of the potential role of case-crossover study design in identifying risk factors for occupational injuries.
• Participants will gain an understanding of important differences in workday structure that put medical trainees at increased risk for injury.
• Participants will be able to place emerging information on fatigue and injury risk in trainees in the broader context of medical errors and patient safety in healthcare.

Keywords: Injuries, Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.