Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians

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 +/- 1.0) compared with RCWR (2.9 +/- 0.7). Reaction time and subjective alertness were also significantly higher, by similar to 18% and similar to 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.

Automated summary

The study revealed that extended-duration work rosters negatively impacted resident-physician performance, while limiting shift duration helped improve performance. Additionally, attentional failures were associated with serious medical errors.