Journal
NEW ENGLAND JOURNAL OF MEDICINE
Volume 351, Issue 18, Pages 1829-1837Publisher
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa041404
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Funding
- AHRQ HHS [K08 HS13333, R01 HS12032, F32 HS14130] Funding Source: Medline
- NCRR NIH HHS [M01 RR02635] Funding Source: Medline
- NHLBI NIH HHS [T32 HL079010] Funding Source: Medline
- NIOSH CDC HHS [R01 OH07567] Funding Source: Medline
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BACKGROUND: Knowledge of the physiological effects of extended (24 hours or more) work shifts in postgraduate medical training is limited. We aimed to quantify work hours, sleep, and attentional failures among first-year residents (postgraduate year 1) during a traditional rotation schedule that included extended work shifts and during an intervention schedule that limited scheduled work hours to 16 or fewer consecutive hours. METHODS: Twenty interns were studied during two three-week rotations in intensive care units, each during both the traditional and the intervention schedule. Subjects completed daily sleep logs that were validated with regular weekly episodes (72 to 96 hours) of continuous polysomnography (r=0.94) and work logs that were validated by means of direct observation by study staff (r=0.98). RESULTS: Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P<0.001), slept 5.8 hours per week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of attentional failures while working during on-call nights (P=0.02) on the intervention schedule as compared with the traditional schedule. CONCLUSIONS: Eliminating interns' extended work shifts in an intensive care unit significantly increased sleep and decreased attentional failures during night work hours.
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