Extended Work Shifts and the Risk of Motor Vehicle Crashes Among Interns

Abstract

It is not uncommon for interns in the United States to work extended shifts of 24 hours or longer. The marked increase in fatigue-related crashes and trucker deaths has been related to consecutive driving hours, prompting this survey of interns nationwide to detect any associations among work hours, extended shifts, and driving safety. A web-based survey was completed by 2737 interns, 80% of those receiving it. They completed 19,740 monthly reports of work hours, motor vehicle crashes, and near misses, as well as episodes of involuntary sleep. Participants were similar demographically to all interns matched through the National Resident Matching Program in 2002. Just over half the respondents were female. The mean age was 28 years. Nearly 80% were in medical specialties. The interns averaged 71 hours in the hospital each week and were awake for all but 3 hours. They spent an additional 4 hours weekly working or studying outside the hospital. Days off per month—including weekends, holidays, and allocated time off—averaged 6.5. The average number of extended work shifts per month was 4, and their average duration was 32 hours. In more than 85% of monthly surveys, the interns reported having worked extended shifts without night-float coverage. The longest time of continuous work averaged 28 hours. There were reports of 320 motor vehicle crashes, 133 of which were consequential (led to emergency treatment, caused at least $1000 in property damage, or prompted filing of a police report). The risk of a crash or near miss was significantly greater for interns commuting from work after an extended shift than after a nonextended shift. Every extended shift that was scheduled per month increased the monthly rate of motor vehicle crashes by 9% and increased crashes on the commute from work by 16%. The risk of falling asleep while driving or when stopped in traffic also rose significantly with the number of extended shifts per month. These findings indicate that interns commuting after an extended work shift are more than twice as likely to have a motor vehicle crash than those returning from a nonextended shift. This is a serious but preventable safety hazard for both the interns themselves and other motorists. Findings from other studies suggest that working an extended shift predisposes to failure of attention and to serious medical errors.

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