Effects on resident work hours, sleep duration, and work experience in a randomized order safety trial evaluating resident-physician schedules (ROSTERS)

Abstract

Study Objectives We compared resident physician work hours and sleep in a multicenter clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hr) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours. Methods Three hundred two resident physicians were enrolled and completed 370 1 month pediatric intensive care unit rotations in six US academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via daily electronic diary. Results Resident physicians worked fewer total hours per week during the RCWR compared with the EDWR (61.9 ± 4.8 versus 68.4 ± 7.4, respectively; p < 0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR, 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hr) compared with the EDWR (49.1 ± 5.8 hr, p < 0.0001). The percentage of 24 hr intervals with less than 4 hr of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p < 0.0001). Conclusions RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts, and improving sleep duration of resident physicians. Although inclusion of the six operational healthcare sites increases the generalizability of these findings, there was heterogeneity in schedule implementation. Additional research is needed to optimize scheduling practices allowing for sufficient sleep prior to all work shifts. Clinical Trial: Multicenter Clinical Trial of Limiting Resident Work Hours on ICU Patient Safety (ROSTERS), https://clinicaltrials.gov/ct2/show/NCT02134847

Health Risks and Potential Predictors of Fatigue and Sleepiness in Airline Cabin Crew

“…With increased number of duty days rostered in a week, being associated with greater levels of fatigue and a rise in perception of safety being compromised due to fatigue. Research in the healthcare industry has found that reducing the number of shifts and/or consecutive work hours for doctors improves sleep duration [64] and significantly lowers the number of medical errors [65]. The aviation industry may apply similar changes, such as introducing more rest days between trips to reduce fatigue and sleepiness.…”

Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians

“…As we reported elsewhere, under the EDWR, resident-physicians slept significantly less (mean 6 SD, 47.5 6 4.5 hours per week) as compared with the RCWR (49.1 6 4.9 hours per week). 23 Importantly, the distribution of sleep loss relative to work was also altered: During the EDWR, 10% of work hours were preceded by #2 hours of sleep in the preceding 24 hours, as compared with only 4% during the RCWR. Furthermore, the percentage of work hours preceded by $8 hours of sleep in the last day was higher during the RCWR (38%) than the EDWR (23%).…”

“…Furthermore, the percentage of work hours preceded by $8 hours of sleep in the last day was higher during the RCWR (38%) than the EDWR (23%). 23 The direct demonstration of a significant correlation between attentional failures as measured by the PVT and medical errors is important because the PVT is easier to measure and has been used extensively to evaluate the impact of work schedules on performance. The correlation observed between this laboratory measure and the risk of medical errors is consistent with a previous meta-analysis revealing that 24 hours of sleep loss had a similar impact on laboratory measures of performance in nonphysicians as it did on clinical…”

Pediatric Resident Engagement With an Online Critical Care Curriculum During the Intensive Care Rotation*

“…One schedule cohort involved daytime and nighttime work shifts limited to a maximum of 16 hours of duration, whereas the second involved traditional extended duration (>24 hr) work shifts, with daytime shifts alternating with extended duration work shifts every fourth night. On average, residents worked about 10% more hours per week on the extended duration work schedule ( 5 ). Throughout this article, we refer to these differing schedule cohorts as “short call” and “long call”.…”