Examining the impact of scheduling on patient safety

The working hours of health care providers has been a topic of debate for years with the need for available staff working long hours pitted against the risk for serious medical error due to lack of sleep. A report in Pediatrics compared extended-duration work rosters, which includes shifts of 24+ hours, and rapid cycling work rosters, which limits shifts to 16 hours and is standard for postgraduate year (PGY) 1 resident-physicians only, in PGY 2 and PGY 3 resident-physicians.¹

The researchers used data from resident-physicians from 9 US pediatric intensive care units. The participants either worked a 4-week extended-duration work roster, with a shift of 24+ hours every third or fourth shift, or worked a rapid cycling work rosters with most shifts being ≤16 consecutive hours. Each resident-physician was asked to completed a daily sleep and work log. They also completed a 10-minute Psychomotor Vigilance Task and Karolinska Sleepiness Scale about 2 to 5 times per shift roughly once a week, as the demands of the job permitted.

A total of 294 resident-physicians participated in the investigation. The researchers found that the overall average number of attentional failures was significantly higher for those on the extended-duration work roster (6.8 ± 1.0) when compared to rapid cycling work rosters (2.9 ± 0.7). Additionally, reaction time and subjective alertness were significantly higher by ∼18% and ∼9%, respectively (both P <.0001) and these difference occurred across the entire 4-week rotation. Attentional failures were linked to resident-physician–related serious medical errors (P =.04). A higher rate of serious medical errors was noted under the rapid cycling work roster, but after adjusting for workload it was found to have a protective effect on the rate of serious medical errors (rate ratio 0.48, 95% CI: 0.30–0.77).

The researchers concluded that the performance impairment linked to extended-duration work rosters was improved by limiting the duration of shifts. This information as well as the impact it has on serious medical errors adds further information on how scheduling can have major impact on patient safety.

Reference

1. Rahman S, Sullivan J, Barger L, et al. Extended work shifts and neurobehavioral performance in resident-physicians. Pediatrics. February 22, 2021. Epub ahead of print. doi:10.1542/peds.2020-009936