Longer shifts don’t create chronic sleep loss or reduce patient safety
Studies show that patient safety was unaffected, and residents showed no signs of chronic sleep loss regardless of shift length for first-year doctors.
When medical residents were permitted to work shifts longer than 16 hours, patient mortality was not affected and the doctors themselves did not experience chronic sleep loss, according to a pair of papers published in the New England Journal of Medicine by a team of researchers from the Perelman School of Medicine, Children’s Hospital of Philadelphia, Johns Hopkins University, and Brigham and Women’s Hospital in Massachusetts. The study that resulted in the papers follows a 2011 change imposed by the Accreditation Council for Graduate Medical Education (ACGME) to limit the amount of hours first-year residents could work in a single shift—a cap of 16 hours per day and 80 hours per week—which came in response to concerns about the potential for mistakes to be made by young doctors working long shifts. The results from these studies suggest that those well-intentioned policies were not necessary to protect patients.
The work is part of an ongoing research effort—the individualized comparative effectiveness of models optimizing patient safety and resident education (iCOMPARE) study—funded by the National Institutes of Health and ACGME. Both papers add to research published in the New England Journal of Medicine by the same team last year, which showed the shift restrictions had little effect on how the residents spent their time or scored on tests of medical knowledge.
“A lesson here is that although there was a lot of concern about shift limits, they really don’t seem to have an effect on any important domains, such as patient safety, when applied in the current context,” says David Asch, a professor of medicine at Penn, and principal investigator for iCOMPARE. “Through iCOMPARE, we were able to use a single study to examine the impact of resident on-duty hours on their sleep and alertness, the safety of the patients they cared for, and the education the residents received, all at once. In the past, what research there has been only looked at one of these factors at a time.”
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