healthier doctors, healthier patients hpa 430 policy action plan amy huang fall, 2008
TRANSCRIPT
Healthier Doctors, Healthier Patients
HPA 430Policy Action Plan
Amy HuangFall, 2008
Proposal:
Encourage the resident physicians at UIC Medical Center to lead healthier lifestyles by targeting three major areas: nutrition, physical activity, and sleep
Expand to a national movement for all teaching hospitals in the U.S.
Background information: Resident physicians are doctors-in-training
in specific fields after graduating from medical schools. Length range from 3-7 years
Traditionally, residents spend >100 hours per week in the hospital1
Patient and Physician Safety and Protection Act2 (H.R. 3236, S. 2614) Limits resident work hours to 80 h/wk or less Introduced to Senate and House, heard in
subcommittees but never passed
Background information: In 2003, the Accreditation Council for
Graduate Medical Education (ACGME) adopted the policy to limit resident duty hours to an average of 80 hours per week Violations of duty hours are usually
underreported, due to fear of losing accreditation3
In Europe, residents work much less. In UK, residents are limited to 56 hours per week and shifts no longer than 12 hours4
Life of a resident: Arrive at hospital between
5am to 7am Typically leave hospital
after 5pm No official lunch break Overnight call every 3 to 5
nights Average 4 days off in 1
month
Three major concerns: Poor nutrition
“I eat junk. I eat crap because it’s like the only happiness in my day right now.”5
Vitamin D deficiency. 50% of residents are deficient.6 (24% in general young adults7)
Physical inactivity 65% of the residents exercise less than twice a
week14
94% would work out more if they had more time14
Sleep deprivation Caffeine dependency 76% of residents feel too tired to drive home after
overnight calls14
Why focus on residents? Physician errors
More errors when sleep-deprived8 Better patient outcome with new regulation9
Safety – patients and residents Car accidents10
Accidental needle sticks11
Role models Residents who lead healthier lives tend to be
better counselors to patients12,13
Improve productivity and efficiency
Nutrition: UIC Medical Center’s cafeteria:
Garden Café opens only from 7am to 7pm no nutritional labels available minimal healthy alternatives
Resident survey: 98% of residents feel our cafeteria food
is less than nutritious14
83% would eat at the cafeteria more if there were healthier options14
Proposal - nutrition: Garden Café should provide nutritional
information on all food served Strive towards a no trans-fat, low
sodium kitchen Healthier options
Physical inactivity:
No time for exercise
Too tired/burned out to exercise
No convenient facility to exercise
Proposal - physical activity: Encourage walking or biking to work
Incentive for bikers/walkers More bike racks, safer locations
iClimb: program to encourage use of stairs in hospital Swipe ID card to track number of stairs climbed Reward residents who log the most number of stairs Also saves energy by decreasing elevator use
Proposal - physical activity: Provide a room with some exercise
equipments treadmill, stationary bike, free weights ping pong table, pool table free access for residents
Sleep-deprivation:
64% of residents feel sleep-deprived more than half of the time14
Average 1-2 hours of sleep on call
Proposal - sleep: Make ACGME duty hour guidelines a
federal regulation separate enforcement body from
accreditation Free cab vouchers for post call
residents example: Rush University Medical Center
Improve environment of call rooms clean sheets, blankets manual temperature control
Potential partners at UIC: Graduate Medical Education Committee (GMEC)
Regulates all residency functions Meets once a month Resident representative: Drs. Shikha Jain, Neel S
hah, and Daina Alexander Nutrition and Wellness Center
Director: Dr. Theodore Mazzone Employee Health Department
Started the walking mentor program at UIC Would be a proponent for iClimb
Sponsors at UIC: Dr. Fred Zar
Program director of internal medicine residency
Great advocate for all residents
Dr. Rachel Caskey Associate program director of
combined med-peds residency
Also a faculty member at UIC School of Public Health
Interest in adult preventative medicine
Sponsors at UIC:
Dean Joseph Flaherty Dean of medical school
Dr. Prakash Desai Medical Director of UIC
Medical Center
Other potential sponsors on the local level:
Dr. Kenneth Schmidt Member of U of Illinois’s Board of T
rustee Graduated from UIC medical school Part of University of Illinois President
’s council Also member of Chicago Medical Soc
iety
Other potential sponsors on the local level:
Commissioner Robert Steele Represents District 2 of Cook County A member of the Health and Hospital
s Public Health committee
Partners on the national level: Committee of Interns and Reside
nts of SEIU Healthcare National President, Dr. Luella Toni Le
wis
American Medical Student Association
National President, Dr. Michael Ehlert
Sponsors on the national level:
Congressman John Conyers (MI) Sponsored H.R. 3236,
the original Patient and Physician Safety and Protection Act in 2001
Congressman Danny K. Davis (IL) Represents District 7 of
IL, including UIC A co-sponosor of H.R.
3236
Sponsors on the national level:
Sponsors on the national level:
Congressman Frank Pallone (NJ) Heads the House
Subcommittee on Health Also a co-sponsor of H.R.
3236
Goal:
Healthier, more-rested, and happier residents = better
patient care!
References:1. Tracey B. Ehlers. "The Patient and Physician Safety and Pr
otection Act: Crucial federal legislation to improve the lives of residents and patients.” Connecticut Public Interest Law Journal. Paper 34, 2004.
2. http://thomas.loc.gov/3. Landrigan, et. al. “Interns’ compliance with ACGME wor
k-hour limits.” JAMA. 2006, 296(9). 4. Butterfield, Stacey. “Shorter hours, fewer nights: Life as a
British resident.” ACP Hospitalist. Oct 2007.5. Stoller et al. “Strategies resident-physicians use to mana
ge sleep loss and fatigue.” Med Educ Online. 2005, 10:9.
References:6. Haney et al. “Vitamin D insufficiency in internal medicine
residents.” Calcified Tissue International. 2005, 76:11.7. Gordon et al. “Prevalence of vitamin D deficiency among
healthy adolescents.” Archives of Peds and Adolescent Med. June, 2004, 158(6).
8. Barger et al. “Impact of extended-duration shifts on medical errors, adverse events, and attentional failures.” Public Library of Science Medicine, Dec. 2006 3(12).
9. Volpp, et. al. “Mortality among patients in VA hospitals in the first 2 Years following ACGME resident duty hour reform.” JAMA. 2007, 298(9):984-992.
10. Barger, et. al. “Extended work shifts and the risk of motor crashes among interns.” NEJM. 2005, 352(2).
References:11. Ayas, et al. “Extended work duration and the risk of self-r
eported percutaneous injuries in interns.” JAMA. 2006, 296(9).
12. Abramson S et al. “Personal exercise habits and counseling practices of primary care physicians: a national survey.” Clin J Sport Medicine. 2000, 10(1).
13. Frank E et al. “Exercise counseling and personal exercise habits of US women physicians.” J Am Med Womens Assoc. 2003, 58(3).
14. Residency survey conducted by Amy Huang, MD. Chicago, IL, 2008.