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Sleep. 2019 May 20. pii: zsz110. doi: 10.1093/sleep/zsz110. [Epub ahead of print]

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

Author information

1
Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA.
2
Division of Sleep Medicine, Harvard Medical School, Boston, MA.
3
California Pacific Medical Center Research Institute, San Francisco, California.
4
Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton VIC, Australia.
5
Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO.
6
University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
7
Seattle Children's Hospital, Seattle, WA.
8
University of Washington, Seattle WA.
9
Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
10
University of Virginia Children's Hospital, Charlottesville, VA.
11
Department of Neurology, Northwestern University, Feinberg School of Medicine, Chicago, IL.
12
Center for Circadian and Sleep Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
13
Division of Critical Care Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA.
14
Children's Hospital Colorado Anschutz Medical Campus, Aurora, CO.
15
Division of General Pediatrics, Department of Pediatrics, Boston Children Hospital, Boston, MA.

Abstract

STUDY OBJECTIVES:

We compared resident physician work hours and sleep in a multi-center clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hours) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours.

METHODS:

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 daily electronic diary.

RESULTS:

Resident physicians worked fewer total hours per week during the RCWR compared to 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 hours) compared to the EDWR (49.1±5.8 hours, p<0.0001). The percentage of 24-hour intervals with less than 4 hours 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.

KEYWORDS:

Actigraphy; Fatigue; Medical Education; Sleep; Sleep Diary; Work hours

PMID:
31106381
DOI:
10.1093/sleep/zsz110

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