Effects of a Night-Team System on Resident Sleep and Work Hours

Abstract

Implementation of a night-team system was unexpectedly associated with decreased sleep hours. As residency programs create work schedules that are compliant with the 2011 Accreditation Council for Graduate Medical Education duty-hour standards, resident sleep should be monitored carefully.

The Effect of Restricting Residents' Duty Hours on Patient Safety, Resident Well-Being, and Resident Education: An Updated Systematic Review

“…29,30,[33][34][35][36]41,43,46 A minority of studies found a favorable impact on resident well-being (4 of 17, 24%; TABLE 2). 32,33,45,48 When analyzed by intervention type, the most frequent result of shift length changes was no impact (8 of 20, 40%), 23,24,27,28,31,32,34,35 that of night float was an unfavorable impact (10 of 18, 56%), [35][36][37][38][39][41][42][43]46,47 and for protected time for sleep, 1 study reported a favorable outcome for resident wellness (1 of 2, 50%) 48 but no impact on patient care, while the other study was unfavorable for resident well-being (1 of 2, 50%). 49 …”

“…5 As a set, the studies had consistent shortcomings in 4 of the 6 dimensions of MERSQI quality measures. Most frequently, analyses were based on a single institution setting (19 of 27, 70%), [23][24][25]28,[31][32][33][34][35][36][37][38][39][40][41][42][43]45,49 outcomes were assessed through self-reporting (15 of 27, 56%), 27 …”

“…TABLE 3B shows the study design, quality score, and outcomes of the 12 studies examining night float. [36][37][38][39][40][41][42][43][44][45][46][47] Studies predominantly examined resident well-being (10 of 12, 83%), [37][38][39][41][42][43][44][45][46][47] and the majority reported unfavorable outcomes (6 of 10, 60%), such as decreased sleep, 36,38,43 higher fatigue, 39,47 and higher stress, 43 compared to traditional call. The majority of studies that examined educational outcomes demonstrated worse outcomes with night float (4 of 6, 67%), with decreased attendance at teaching conferences, 36,[41][42][43] less time per week spent with attending physician, 43 and less time for independent reading.…”

Achieving Balance on the Inpatient Internal Medicine Wards

“…In a report on the implementation of a night float system at Children's Hospital in Boston, Chua and colleagues 4 found that total sleep time decreased under the night float system, and ultimately their program reverted back to a traditional call system. Similarly, Desai and colleagues 5 reported testing two systems-both compliant with the 2011 ACGME Common Program Requirements-on the inpatient internal medicine wards at Johns Hopkins.…”

Twelve tips for overnight teaching

“…In addition, although night float systems decrease the amount of time that residents are in the hospital, such systems are associated with decreased sleep (Chua et al 2011). Therefore, residents working overnight in a night float system may be less well-rested and less able to engage in cognitively demanding work, including learning, than the same residents on day rotations (Durmer & Dinges 2005;Curcio et al 2006).…”