Resident Physicians are at Increased Risk for Dangerous Driving after Extended-duration Work Shifts: A Systematic Review

Abstract

Background: Resident physicians often work longer than 24 consecutive hours with little or no sleep. A systematic review of the literature was conducted to investigate the risk of resident physician motor vehicle collisions (MVC), and dangerous driving, after extended-duration work shifts (EDWS). Material and methods: A keyword search was performed for original research articles evaluating any aspect of driving safety following EDWS for the resident physician population. Two authors independently reviewed articles for inclusion. Subsequent independent data abstraction and quality appraisal were carried out. Five articles met the study inclusion criteria. Results: The quality of the evidence was low to very low. Results were not pooled due to study heterogeneity. Residents reported between 2.3 to 3.8 hours of sleep during EDWS. Three survey-based studies identified an increased risk of MVCs and falling asleep at the wheel after EDWS. One study associated weekly cumulative sleep hours lost with the risk of falling asleep while driving. Both driving simulation and survey studies linked EDWS with MVCs. Notably, a driving simulation study found an increase in crash frequency in male residents post-EDWS. Additionally, a survey reported that the risk of an MVC post-EDWS increased by 16.2% per shift worked in a month. Conclusion: The period following EDWS is associated with an increased risk of potentially life-threatening driving safety risks for resident physicians. These observations warrant careful consideration. They suggest that there is a need for greater awareness and action in order to avoid the occupational and public health risks of driving after EDWS.

Pediatric Resident’s Perception of Night Float System Compared to 24 Hours System, a Prospective Study

“…Our study, showed that NF system had signi cant improvement in these three aspects. Several studies showed the traditional on-call system is associated with loss of sleep and fatigue which is like our study results [2][3]. Furthermore, the 24 hour on-call system shown to negatively affect physical function and memory in our pediatric residents and neurosurgery residents in another study [15].…”

“…The limitation of our study were lack of assessment regarding the risk of motor vehicle accidents and near-miss driving events that could be related with loss of sleep and fatigue during long-time shifts [2][3]13]. Also, we did not evaluate the cognitive function which is another limitation [15].…”

“…In addition, a study suggested minimizing work hours and assigning health care workers to speci c rules in order to prevent physician burnout [16]. Moreover, a survey advised a time off to improve residents' well-being as it showed that long duty hours could cause residents burnout which can cause depression, substance abuse, and suicide attempt [2][3]5].…”

“…Furthermore, an increase in burnout and suicide attempt among physicians. As a result, several countries have established the Night Float (NF) shifts system [2][3][4][5][6].…”

Doctors’ Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study

“…There is risk of acute harm to practitioners. A systematic review demonstrated an elevated risk for road traffic incidents in doctors after extended shift work [16]. The largest study included in the review followed 2500 junior doctors in the USA over a year and found that those working an extended duration shift (>24 h) were 2.3 times more likely to have a motor vehicle car crash, and 5.9 times more likely to have a near miss, than following a non-extended duration shift [17].…”