Sleep

Getting a good night’s sleep is important for everyone including physicians. In 2011, the Accreditation Council for Graduate Medical Education (ACGME) set a limit on first-year resident physician shifts of 16 or fewer continuous hours of work. This policy change was base primarily on the results of studies comparing outcomes for first year residents who work extend duration work shifts (24 hours or more) to those who work rapid-cycling work shifts.

Senior resident physicians

But data for more senior resident physicians has lacking. Currently, resident physicians are permit to work extended-duration shifts of up to 28 hours after their first postgraduate year. A new study led by investigators from Brigham and Women’s Hospital is the first multi-center randomize clinical trial of senior resident physicians to compare the work hours and sleep obtaine by those working extend shifts with those whose schedule shift lengths were limit to no more than 16 consecutive hours.

The team’s results are presented today at the American Thoracic Meeting; also simultaneously publish in Sleep. Sleep deficiency impairs performance and patient safety; so adversely affects the mental and physical health of resident physicians and increases their risk of occupational injury and motor vehicle crashes,” said senior author Charles Czeisler, Ph.D., MD, FRCP, chief of the Division of Sleep and Circadian Disorders at the Brigham, who present the findings at the meeting.

This operational trial, conduct in six pediatric intensive care units across the country; so show that rosters eliminating schedule extended duration shifts reduce weekly work hours; also improve sleep of resident physicians. The current study enroll 302 resident physicians; so working in pediatric intensive care units at six U.S. academic medical centers.

Crossover clinical trial

Sleep was measure using wrist-worn actigraphs, and work hours and sleep data were collect using electronic diaries. In the cluster randomize crossover clinical trial; so resident physicians were randomize to an Extend Duration Work Roster (EDWR), with extended-duration (24 hours or more) shifts, or a Rapidly Cycling Work Roster (RCWR); which schedule shift lengths was limit to 16 or fewer consecutive hours.

Resident physicians work 10% fewer total hours per week during the RCWR; which compare to the EDWR and obtaine significantly more sleep per week. Weekly sleep duration increase nearly four hours overall in the RCWR as compare to the EDWR. The authors note that the RCWR schedule was implement differently; so across the six hospitals and that more information is need about optimal scheduling practices; so that ensure enough opportunity for residents to sleep.

There is a compelling need for the design of schedules that enable sufficient sleep; so in settings that require safety-sensitive 24-hour operations, said corresponding author Laura Barger; hence an associate physiologist in the Division of Sleep and Circadian Disorders. These findings extend the evidence from our previous single-site study; so provide data on more senior resident physicians; hence indicate that eliminating extended duration shifts may improve sleep duration for senior resident physicians.