Extended work shifts and neurobehavioral performance in resident-physicians

Shadab A. Rahman, Jason P. Sullivan, Laura K. Barger, Melissa A. St. Hilaire, Conor S. O'Brien, Katie L. Stone, Andrew J.K. Phillips, Elizabeth B. Klerman, Salim Qadri, Kenneth P. Wright, Ann C. Halbower, Jeffrey L. Segar, John K. McGuire, Michael V. Vitiello, Horacio O. de la Iglesia, Sue E. Poynter, Pearl L. Yu, Amy L. Sanderson, Phyllis C. Zee, Christopher P. LandriganCharles A. Czeisler, Steven W. Lockley, The Rosters Study Group

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19 Citations (Scopus)

Abstract

OBJECTIVES: Extended-duration work rosters (EDWRs) with shifts of 241 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 241 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 (6 SE) number of attentional failures was significantly higher (P =.01) on the EDWR (6.8 6 1.0) compared with RCWR (2.9 6 0.7). Reaction time and subjective alertness were also significantly higher, by ∼18% and ∼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.

Original languageEnglish
Article numbere2020009936
Number of pages14
JournalPediatrics
Volume147
Issue number3
DOIs
Publication statusPublished - Mar 2021

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