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.