Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians
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. Data from 294 r...
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| Veröffentlicht in: | Pediatrics (Evanston) 2021-03, Vol.147 (3), p.1 |
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| creator | Rahman, Shadab A Sullivan, Jason P Barger, Laura K St Hilaire, Melissa A O'Brien, Conor S Stone, Katie L Phillips, Andrew J K Klerman, Elizabeth B Qadri, Salim Wright, Jr, Kenneth P Halbower, Ann C Segar, Jeffrey L McGuire, John K Vitiello, Michael V de la Iglesia, Horacio O Poynter, Sue E Yu, Pearl L Sanderson, Amy L Zee, Phyllis C Landrigan, Christopher P Czeisler, Charles A Lockley, Steven W |
| description | 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.
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.
Overall, the mean (± SE) number of attentional failures was significantly higher (
=.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 ∼18% and ∼9%, respectively (both |
| doi_str_mv | 10.1542/peds.2020-009936 |
| format | Article |
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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.
Overall, the mean (± SE) number of attentional failures was significantly higher (
=.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 ∼18% and ∼9%, respectively (both
<.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (
=.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]).
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><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2020-009936</identifier><identifier>PMID: 33619044</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adult ; Attention - physiology ; Behavior ; Female ; Health aspects ; Hours of labour ; Humans ; Intensive Care Units, Pediatric ; Internship and Residency ; Male ; Medical Errors - statistics & numerical data ; Medical residencies ; Patient safety ; Pediatrics ; Psychological aspects ; Psychomotor Performance - physiology ; Reaction time task ; Residents (Medicine) ; Shift work ; Shift Work Schedule - adverse effects ; Shift Work Schedule - statistics & numerical data ; Sleep ; Sleep and wakefulness ; Sleep Deprivation - complications ; Sleep Deprivation - physiopathology ; Sleepiness ; Task Performance and Analysis ; Time Factors ; Vigilance ; Wakefulness - physiology ; Work hours ; Work Schedule Tolerance - physiology ; Working hours ; Workload - psychology ; Workload - statistics & numerical data</subject><ispartof>Pediatrics (Evanston), 2021-03, Vol.147 (3), p.1</ispartof><rights>Copyright © 2021 by the American Academy of Pediatrics.</rights><rights>COPYRIGHT 2021 American Academy of Pediatrics</rights><rights>Copyright American Academy of Pediatrics Mar 1, 2021</rights><rights>Copyright © 2021 by the American Academy of Pediatrics 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c528t-f4f4fb08ac080ce7b0caf1eae3ef89ce69ca2e15f73cbdd7cd9c3738d2d73f253</citedby><cites>FETCH-LOGICAL-c528t-f4f4fb08ac080ce7b0caf1eae3ef89ce69ca2e15f73cbdd7cd9c3738d2d73f253</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33619044$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rahman, Shadab A</creatorcontrib><creatorcontrib>Sullivan, Jason P</creatorcontrib><creatorcontrib>Barger, Laura K</creatorcontrib><creatorcontrib>St Hilaire, Melissa A</creatorcontrib><creatorcontrib>O'Brien, Conor S</creatorcontrib><creatorcontrib>Stone, Katie L</creatorcontrib><creatorcontrib>Phillips, Andrew J K</creatorcontrib><creatorcontrib>Klerman, Elizabeth B</creatorcontrib><creatorcontrib>Qadri, Salim</creatorcontrib><creatorcontrib>Wright, Jr, Kenneth P</creatorcontrib><creatorcontrib>Halbower, Ann C</creatorcontrib><creatorcontrib>Segar, Jeffrey L</creatorcontrib><creatorcontrib>McGuire, John K</creatorcontrib><creatorcontrib>Vitiello, Michael V</creatorcontrib><creatorcontrib>de la Iglesia, Horacio O</creatorcontrib><creatorcontrib>Poynter, Sue E</creatorcontrib><creatorcontrib>Yu, Pearl L</creatorcontrib><creatorcontrib>Sanderson, Amy L</creatorcontrib><creatorcontrib>Zee, Phyllis C</creatorcontrib><creatorcontrib>Landrigan, Christopher P</creatorcontrib><creatorcontrib>Czeisler, Charles A</creatorcontrib><creatorcontrib>Lockley, Steven W</creatorcontrib><creatorcontrib>ROSTERS STUDY GROUP</creatorcontrib><creatorcontrib>THE ROSTERS STUDY GROUP</creatorcontrib><title>Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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.
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.
Overall, the mean (± SE) number of attentional failures was significantly higher (
=.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 ∼18% and ∼9%, respectively (both
<.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (
=.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]).
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><subject>Adult</subject><subject>Attention - physiology</subject><subject>Behavior</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hours of labour</subject><subject>Humans</subject><subject>Intensive Care Units, Pediatric</subject><subject>Internship and Residency</subject><subject>Male</subject><subject>Medical Errors - statistics & numerical data</subject><subject>Medical residencies</subject><subject>Patient safety</subject><subject>Pediatrics</subject><subject>Psychological aspects</subject><subject>Psychomotor Performance - physiology</subject><subject>Reaction time task</subject><subject>Residents (Medicine)</subject><subject>Shift work</subject><subject>Shift Work Schedule - adverse effects</subject><subject>Shift Work Schedule - statistics & numerical data</subject><subject>Sleep</subject><subject>Sleep and wakefulness</subject><subject>Sleep Deprivation - complications</subject><subject>Sleep Deprivation - physiopathology</subject><subject>Sleepiness</subject><subject>Task Performance and Analysis</subject><subject>Time Factors</subject><subject>Vigilance</subject><subject>Wakefulness - physiology</subject><subject>Work hours</subject><subject>Work Schedule Tolerance - physiology</subject><subject>Working hours</subject><subject>Workload - psychology</subject><subject>Workload - statistics & numerical data</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkUtv1DAUhS0EokNhzwpFYsMm5foVxxukalQeoqIVD7G0HPtmxiVjT-2kav89iaZUgLy4C3_33HN0CHlJ4YRKwd7u0ZcTBgxqAK1584isKOi2FkzJx2QFwGktAOQReVbKFQAIqdhTcsR5QzUIsSKfz25HjB599TPlX9W3bejHUtnoqy845dTh1t6ElO1QXWLuU97Z6LAKsfqKJXiMY325vSvBBRvLc_Kkt0PBF_fzmPx4f_Z9_bE-v_jwaX16XjvJ2rHuxfw6aK2DFhyqDpztKVrk2LfaYaOdZUhlr7jrvFfOa8cVbz3zivdM8mPy7qC7n7odeje7mA2afQ47m-9MssH8-xPD1mzSjVGaakrVLPDmXiCn6wnLaHahOBwGGzFNxTChWSOVlsut1_-hV2nKcY63UA2XVGo6U_WB2tgBTYguxRFvR5eGATdo5vTrC3PaaMFaxfjCw4F3OZWSsX8wT8EszZqlWbM0aw7Nziuv_g79sPCnSv4b3qWg2A</recordid><startdate>202103</startdate><enddate>202103</enddate><creator>Rahman, Shadab A</creator><creator>Sullivan, Jason P</creator><creator>Barger, Laura K</creator><creator>St Hilaire, Melissa A</creator><creator>O'Brien, Conor S</creator><creator>Stone, Katie L</creator><creator>Phillips, Andrew J K</creator><creator>Klerman, Elizabeth B</creator><creator>Qadri, Salim</creator><creator>Wright, Jr, Kenneth P</creator><creator>Halbower, Ann C</creator><creator>Segar, Jeffrey L</creator><creator>McGuire, John K</creator><creator>Vitiello, Michael V</creator><creator>de la Iglesia, Horacio O</creator><creator>Poynter, Sue E</creator><creator>Yu, Pearl L</creator><creator>Sanderson, Amy L</creator><creator>Zee, Phyllis C</creator><creator>Landrigan, Christopher P</creator><creator>Czeisler, Charles A</creator><creator>Lockley, Steven W</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>202103</creationdate><title>Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians</title><author>Rahman, Shadab A ; Sullivan, Jason P ; Barger, Laura K ; St Hilaire, Melissa A ; O'Brien, Conor S ; Stone, Katie L ; Phillips, Andrew J K ; Klerman, Elizabeth B ; Qadri, Salim ; Wright, Jr, Kenneth P ; Halbower, Ann C ; Segar, Jeffrey L ; McGuire, John K ; Vitiello, Michael V ; de la Iglesia, Horacio O ; Poynter, Sue E ; Yu, Pearl L ; Sanderson, Amy L ; Zee, Phyllis C ; Landrigan, Christopher P ; Czeisler, Charles A ; Lockley, Steven W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c528t-f4f4fb08ac080ce7b0caf1eae3ef89ce69ca2e15f73cbdd7cd9c3738d2d73f253</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Attention - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rahman, Shadab A</au><au>Sullivan, Jason P</au><au>Barger, Laura K</au><au>St Hilaire, Melissa A</au><au>O'Brien, Conor S</au><au>Stone, Katie L</au><au>Phillips, Andrew J K</au><au>Klerman, Elizabeth B</au><au>Qadri, Salim</au><au>Wright, Jr, Kenneth P</au><au>Halbower, Ann C</au><au>Segar, Jeffrey L</au><au>McGuire, John K</au><au>Vitiello, Michael V</au><au>de la Iglesia, Horacio O</au><au>Poynter, Sue E</au><au>Yu, Pearl L</au><au>Sanderson, Amy L</au><au>Zee, Phyllis C</au><au>Landrigan, Christopher P</au><au>Czeisler, Charles A</au><au>Lockley, Steven W</au><aucorp>ROSTERS STUDY GROUP</aucorp><aucorp>THE ROSTERS STUDY GROUP</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2021-03</date><risdate>2021</risdate><volume>147</volume><issue>3</issue><spage>1</spage><pages>1-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><abstract>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.
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.
Overall, the mean (± SE) number of attentional failures was significantly higher (
=.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 ∼18% and ∼9%, respectively (both
<.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician-related serious medical errors (SMEs) (
=.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]).
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.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>33619044</pmid><doi>10.1542/peds.2020-009936</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0031-4005 |
| ispartof | Pediatrics (Evanston), 2021-03, Vol.147 (3), p.1 |
| issn | 0031-4005 1098-4275 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7919117 |
| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Attention - physiology Behavior Female Health aspects Hours of labour Humans Intensive Care Units, Pediatric Internship and Residency Male Medical Errors - statistics & numerical data Medical residencies Patient safety Pediatrics Psychological aspects Psychomotor Performance - physiology Reaction time task Residents (Medicine) Shift work Shift Work Schedule - adverse effects Shift Work Schedule - statistics & numerical data Sleep Sleep and wakefulness Sleep Deprivation - complications Sleep Deprivation - physiopathology Sleepiness Task Performance and Analysis Time Factors Vigilance Wakefulness - physiology Work hours Work Schedule Tolerance - physiology Working hours Workload - psychology Workload - statistics & numerical data |
| title | Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians |
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