Healthier Doctors, Healthier Patients

1. Healthier Doctors, Healthier Patients HPA 430 Policy Action Plan Amy Huang Fall, 2008

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Proposal - nutrition: • Garden Café should provide nutritional information on all food served • Strive towards a no trans-fat, low sodium kitchen • Healthier options

10. Physical inactivity: • No time for exercise • Too tired/burned out to exercise • No convenient facility to exercise

11. 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

12. Proposal - physical activity: • Provide a room with some exercise equipments • treadmill, stationary bike, free weights • ping pong table, pool table • free access for residents

13. Sleep-deprivation: • 64% of residents feel sleep-deprived more than half of the time14 • Average 1-2 hours of sleep on call

14. 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

15. Potential partners at UIC: • Graduate Medical Education Committee (GMEC) • Regulates all residency functions • Meets once a month • Resident representative: Drs. Shikha Jain, Neel Shah, 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

16. 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

17. Sponsors at UIC: • Dean Joseph Flaherty • Dean of medical school • Dr. Prakash Desai • Medical Director of UIC Medical Center

18. Other potential sponsors on the local level: • Dr. Kenneth Schmidt • Member of U of Illinois’s Board of Trustee • Graduated from UIC medical school • Part of University of Illinois President’s council • Also member of Chicago Medical Society

19. Other potential sponsors on the local level: • Commissioner Robert Steele • Represents District 2 of Cook County • A member of the Health and Hospitals Public Health committee

20. Partners on the national level: • Committee of Interns and Residents of SEIU Healthcare • National President, Dr. Luella Toni Lewis • American Medical Student Association • National President, Dr. Michael Ehlert

21. Sponsors on the national level: • Congressman John Conyers (MI) • Sponsored H.R. 3236, the original Patient and Physician Safety and Protection Act in 2001

22. Sponsors on the national level: • Congressman Danny K. Davis (IL) • Represents District 7 of IL, including UIC • A co-sponosor of H.R. 3236

23. Sponsors on the national level: • Congressman Frank Pallone (NJ) • Heads the House Subcommittee on Health • Also a co-sponsor of H.R. 3236

24. Goal: Healthier, more-rested, and happier residents = better patient care!

25. References: • Tracey B. Ehlers. "The Patient and Physician Safety and Protection Act: Crucial federal legislation to improve the lives of residents and patients.” Connecticut Public Interest Law Journal. Paper 34, 2004. • http://thomas.loc.gov/ • Landrigan, et. al. “Interns’ compliance with ACGME work-hour limits.” JAMA. 2006, 296(9). • Butterfield, Stacey. “Shorter hours, fewer nights: Life as a British resident.” ACP Hospitalist. Oct 2007. • Stoller et al. “Strategies resident-physicians use to manage sleep loss and fatigue.” Med Educ Online. 2005, 10:9.

26. References: • Haney et al. “Vitamin D insufficiency in internal medicine residents.” Calcified Tissue International. 2005, 76:11. • Gordon et al. “Prevalence of vitamin D deficiency among healthy adolescents.” Archives of Peds and Adolescent Med. June, 2004, 158(6). • 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). • 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. • Barger, et. al. “Extended work shifts and the risk of motor crashes among interns.” NEJM. 2005, 352(2).

27. References: • Ayas, et al. “Extended work duration and the risk of self-reported percutaneous injuries in interns.” JAMA. 2006, 296(9). • Abramson S et al. “Personal exercise habits and counseling practices of primary care physicians: a national survey.” Clin J Sport Medicine. 2000, 10(1). • Frank E et al. “Exercise counseling and personal exercise habits of US women physicians.” J Am Med Womens Assoc. 2003, 58(3). • Residency survey conducted by Amy Huang, MD. Chicago, IL, 2008.