Long work hours, overnight call duty, and rotating shifts are implicit features of hospital medical practice. Rigorous schedules have been deemed necessary to fulfill the professional obligation of patient beneficence, to optimize trainee learning, and to respond to economic realities.
However, the resultant disruption and restriction of physicians’ sleep produce demonstrable neurobehavioral impairments that may threaten other fundamental professional mandates, such as that of primum non nocere (“first, do no harm”).
A new study led by investigators from Brigham and Women’s Hospital is the first multicenter randomized clinical trial of senior resident physicians (postgraduate year two and higher) to compare the work hours and sleep obtained by those working extended shifts with those whose scheduled shifts were limited to no more than 16 consecutive hours.
Investigators found that for every pediatrician physician working under the revised schedule, the sleep rate per week increased by 8 percent on average.
302 resident physicians were enrolled and completed 370 one-month pediatric intensive care unit rotations in six U.S. academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via a daily electronic diary.
In the clustered-randomized crossover clinical trial, resident physicians were randomized to an extended duration work roster (EDWR), with shifts of 24 hours or more, or a rapidly cycling work roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours.
Resident physicians worked 10 percent less in less than a week during the RCWR compared to the EDWR and got more sleep in the week. Compared to EDWR, the duration of weekly sleep increased in the RSWR by about four hours.
Corresponding author Laura Barger, an associate physiologist in the Division of Sleep and Circadian Disorders said, “There is a compelling need for the design of schedules that enable sufficient sleep in settings that require safety-sensitive 24-hour operations. These findings extend the evidence from our previous single-site study, provide data on more senior resident physicians, and indicate that eliminating extended-duration shifts may improve sleep duration for senior resident physicians.”
Funding for this work was provided by the National Heart, Lung, and Blood Institute, the National Institutes of Health, and the National Institute for Occupational Safety and Health.
The results were presented at the American Thoracic Society meeting and simultaneously published in the journal Sleep.