Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians

Details

• Personal Author:
  Barger LK ; Czeisler, Charles A. ; de la Iglesia HO ; Halbower AC ; Klerman EB ; Landrigan CP ; Lockley SW ; McGuire JK ; O'Brien CS ; Phillips AJK ; Poynter SE ; Qadri S ; Rahman SA ; Sanderson AL ; Segar JL ; St. Hilaire MA ; Stone KL ; Sullivan JP ; Vitiello MV ; Wright KP Jr. ; Yu PL ; Zee PC
• Description:
  OBJECTIVES: Extended-duration work rosters (EDWRs) with shifts of 24+ hours impair performance compared with rapid cycling work rosters (RCWRs) that limit shifts to 16 hours in postgraduate year (PGY) 1 resident-physicians. We examined the impact of a RCWR on PGY 2 and PGY 3 resident-physicians. METHODS: Data from 294 resident-physicians were analyzed from a multicenter clinical trial of 6 US PICUs. Resident-physicians worked 4-week EDWRs with shifts of 24+ hours every third or fourth shift, or an RCWR in which most shifts were ≤ 16 consecutive hours. Participants completed a daily sleep and work log and the 10-minute Psychomotor Vigilance Task and Karolinska Sleepiness Scale 2 to 5 times per shift approximately once per week as operational demands allowed. RESULTS: Overall, the mean (+/- SE) number of attentional failures was significantly higher (P =.01) on the EDWR (6.8 +/- 1.0) compared with RCWR (2.9 +/- 0.7). Reaction time and subjective alertness were also significantly higher, by approx. 18% and approx. 9%, respectively (both P <.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (P =.04). Although a higher rate of SMEs was observed under the RCWR, after adjusting for workload, RCWR had a protective effect on the rate of SMEs (rate ratio 0.48 [95% confidence interval: 0.30-0.77]). CONCLUSIONS: Performance impairment due to EDWR is improved by limiting shift duration. These data and their correlation with SME rates highlight the impairment of neurobehavioral performance due to extended-duration shifts and have important implications for patient safety. [Description provided by NIOSH]
• Subjects:
  Cohort Studies Health Personnel Nervous System Occupational Health Safety Sleep Sleep Initiation And Maintenance Disorders
• Keywords:
  Cognitive Function Cohort Studies Health Care Workers Medical Personnel Physicians Sleep Deprivation Work Performance Work Schedules
• ISSN:
  0031-4005
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  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)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  147
• Issue:
  3
• NIOSHTIC Number:
  nn:20062375
• Citation:
  Pediatrics 2021 Mar; 147(3):e2020009936
• Contact Point Address:
  Shadab A. Rahman, PhD, MPH, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, 221 Longwood Ave, Boston, MA 02115
• Email:
  sarahman@rics.bwh.harvard.edu
• Federal Fiscal Year:
  2021
• Performing Organization:
  Brigham and Women's Hospital, Boston, Massachusetts
• Peer Reviewed:
  True
• Start Date:
  20130901
• Source Full Name:
  Pediatrics
• End Date:
  20180831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:938de06aaba3f526f1674fe3f334d76aef992b93d6a8e523916e7507e7b32cbd1d600813eab9f2170d63b56cce1b4b084d1a7bf1906ffec67316467ca0120840
• Download URL:
  https://stacks.cdc.gov/view/cdc/225638/cdc_225638_DS1.pdf
• File Type:
  [PDF - 1.48 MB ]