Effects on Resident Work Hours, Sleep Duration, and Work Experience in a Randomized Order Safety Trial Evaluating Resident-Physician Schedules (ROSTERS)

Details

• Personal Author:
  Barger LK ; Blackwell T ; Czeisler, Charles A. ; de la Iglesia HO ; Halbower AC ; Landrigan CP ; Lockley SW ; McGuire JK ; O'Brien CS ; Phillips AJK ; Poynter SE ; Qadri S ; Rahman SA ; ROSTERS Study Group ; Sanderson AL ; Segar JL ; St. Hilaire MA ; Stone KL ; Sullivan JP ; Vitiello MV ; Wright KP Jr. ; Yu PL ; Zee P ; Barger LK ; Blackwell T ; Czeisler, Charles A. ; de la Iglesia HO ; Halbower AC ; Landrigan CP ; Lockley SW ; McGuire JK ; O'Brien CS ; Phillips AJK ; Poynter SE ; Qadri S ; Rahman SA ; ROSTERS Study Group ; Sanderson AL ; Segar JL ; St. Hilaire MA ; Stone KL ; Sullivan JP ; Vitiello MV ; Wright KP Jr. ; Yu PL ; Zee P
• Description:
  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. [Description provided by NIOSH]
• Subjects:
  Health Personnel Occupational Health Safety Shift Work Schedule Sleep Sleep Initiation And Maintenance Disorders
• Keywords:
  Actigraphy Author Keywords: Sleep Fatigue Health Care Personnel Long Work Hours Medical Education Physicians Shift Work Sleep Deprivation Sleep Diary Work Experience Work Hours Work Intervals Work Schedules

  More +
• ISSN:
  0161-8105
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  California ; Colorado ; Illinois ; Iowa ; Massachusetts ; Ohio ; OSHA Region 1 ; OSHA Region 10 ; OSHA Region 3 ; OSHA Region 5 ; OSHA Region 7 ; OSHA Region 8 ; OSHA Region 9 ; Virginia ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Volume:
  42
• Issue:
  8
• NIOSHTIC Number:
  nn:20059388
• Citation:
  Sleep 2019 Aug; 42(8):zsz110
• Contact Point Address:
  Laura K Barger, Brigham Health, Division of Sleep and Circadian Disorders, Harvard Medical School, Division of Sleep Medicine, Boston, MA 02115
• Email:
  LKBarger@HMS.Harvard.edu
• Federal Fiscal Year:
  2019
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20130901
• Source Full Name:
  Sleep
• End Date:
  20180831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d8c6f65674f4b8af1c223b339f82c969c87d72a1c5f1f3d17a3728e347c45d2468af5f0cd780254e21b2966298e115899e500f490741e4f18013748be0c310fc
• Download URL:
  https://stacks.cdc.gov/view/cdc/223643/cdc_223643_DS1.pdf
• File Type:
  [PDF - 3.22 MB ]