Protected sleep, shorter rotations may improve clinicians’ performance

Two studies published in JAMA show that having a period of protected sleep while being on call and having a shorter rotation result in improved alertness and a lower risk for "burnout" and emotional exhaustion in clinicians.

However, while having a 2- versus a 4-week inpatient rotation for more senior (attending or consultant) physicians benefitted their health and did not adversely affect patient outcomes, trainee evaluations of the performance of senior physicians was worse with the 2- versus the 4-week rotation.

In the first study, Kevin Volpp (Philadelphia Veterans Affairs Medical Center, Pennsylvania, USA) and colleagues evaluated whether having a period of "protected" sleep during an extended overnight on-call period could improve alertness the following morning in junior doctors (interns or house officers) or senior medical students.

The team randomly assigned 106 junior doctors or senior medical students to complete 12 4-week blocks that either included standard extended overnight duty shifts of up to 30 hours or similar shifts with a protected sleep period between 12.30 am and 5.30 am, during which time the work cell phone was handed over.

The doctors in the protected sleep group had a mean of 3 hours sleep per night of on-call duty versus 2 hours in the standard group. They were also more alert the next morning, with average scores on the Karolinska sleepiness scale of 6.79-7.10 versus 5.91-6.65.

The authors concede that they did not measure patient outcomes so cannot conclusively say that the protected sleep period lead to better physician performance, but "to the extent that protected sleep periods are feasible and improve alertness, they may provide a reasonable alternative to mandated shorter shifts," they say.

In the second study, led by Brian Lucas (Rush Medical College, Chicago, Illinois, USA), the researchers randomly assigned 62 attending physicians to 2- or 4-week inpatient rotations for 1 academic year (2009).

At 1 year, attending physicians on the 2-week rotation were less likely to have a high score for burnout severity or emotional exhaustion than those on the 4-week rotation, at 16% versus 35% and 19% versus 37%, respectively.

Unplanned patient revisits, a sign of poor medical care when first treated, did not differ significantly between the 2- and 4-week rotations.

However, attending physicians on the shorter rotation were more likely to have a low score regarding their ability to evaluate trainees than those on the longer rotation, as rated by junior doctors and medical students, at 41% versus 28% and 82% versus 69%, respectively.

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