Sleep deprivation in resident physicians, work hour limitations, and related outcomes: A systematic review of the literature

Postgraduate Medicine

Volumn 124, Issue 4, 2012, Pages 241-249

  Mansukhani, Meghna P ^a   Kolla, Bhanu Prakash ^a   Surani, Salim ^b   Varon, Joseph ^c,d,e   Ramar, Kannan ^a  

^a MAYO CLINIC   (United States)

^b TEXAS A AND M UNIVERSITY   (United States)

^c UNIVERSITY OF TEXAS MEDICAL SCHOOL   (United States)

^d UNIVERSITY OF TEXAS MEDICAL BRANCH   (United States)

^e University General Hospital   (United States)

Author keywords

Burnout; Clinical competence; Fatigue; Hours; Internship; Medical errors; Medical training; Psychological; Quality of life; Residency; Safety; Sleep deprivation; Sleep loss; Stress; Well being

Indexed keywords

ALCOHOL CONSUMPTION; ARTICLE; ATTENTION; BURNOUT; CLINICAL RESEARCH; COGNITION; DRUG USE; ECONOMIC ASPECT; EMOTION; EXECUTIVE FUNCTION; FATIGUE; HUMAN; MEDICAL EDUCATION; MEDICAL ERROR; MEDICAL SPECIALIST; MOOD; MOTOR PERFORMANCE; OUTCOME ASSESSMENT; PATIENT CARE; PATIENT SAFETY; PROFESSIONALISM; PROTOCOL COMPLIANCE; REACTION TIME; RESIDENT; SAFETY; SHIFT WORKER; SLEEP DEPRIVATION; SLEEP QUALITY; SYSTEMATIC REVIEW; TRAFFIC ACCIDENT; WELLBEING; WORKING TIME; ACCREDITATION; CIRCADIAN RHYTHM SLEEP DISORDER; CLINICAL COMPETENCE; PHYSIOLOGY; QUALITY OF LIFE; REVIEW; STANDARD; STATISTICS; UNITED STATES; WORK SCHEDULE; WORKLOAD;

ACCREDITATION; CLINICAL COMPETENCE; COGNITION; FATIGUE; HUMANS; INTERNSHIP AND RESIDENCY; MEDICAL ERRORS; QUALITY OF LIFE; SLEEP DEPRIVATION; SLEEP DISORDERS, CIRCADIAN RHYTHM; UNITED STATES; WORK SCHEDULE TOLERANCE; WORKLOAD;

EID: 84871709381     PISSN: 00325481     EISSN: 19419260     Source Type: Journal    
DOI: 10.3810/pgm.2012.07.2583     Document Type: Article

References (73)

1. Afrin LB, Arana GW, Medio FJ, Ybarra AF, Clarke HS Jr. Improving oversight of the graduate medical education enterprise: one institution's strategies and tools. Acad Med. 2006;81(5):419-425.
2. Iglehart JK. Revisiting duty-hour limits-IOM recommendations for patient safety and resident education. N Engl J Med. 2008;359(25):2633-2635.
3. Brown ID. Driver fatigue. Hum Factors. 1994;36(2):298-314.
4. Kowalenko T, Kowalenko J, Gryzbowski M, Rabinovich A. Emergency medicine resident related auto accidents-is sleep deprivation a risk factor? Acad Emerg Med. 2000;7(10):1171.
5. Gopal R, Glasheen JJ, Miyoshi TJ, Prochazka AV. Burnout and internal medicine resident work-hour restrictions. Arch Intern Med. 2005;165(22):2595-600.
6. Accreditation Council for Graduate Medical Education (ACGME). Common Program Requirements. Effective July 1, 2011. http://wwwacgme.org/acwebsite/home/Common_Program_Requirements_07012011.pdf. Accessed June 28, 2012.
7. Earle D. Surgical training and simulation laboratory at Baystate Medical Center. Surg Innov. 2006;13(1):53-60.
8. Okie S. An elusive balance-residents' work hours and the continuity of care. N Engl J Med. 2007;356(26):2665-2667.
9. Koslowsky M, Babkoff H. Meta-analysis of the relationship between total sleep deprivation and performance. Chronobiol Int. 1992;9(2):132-136.
10. Pilcher JJ, Huffcutt AI. Effects of sleep deprivation on performance: a meta-analysis. Sleep. 1996;19(4):318-326.
11. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature. 1997;17;388(6639):235.
12. Arnedt JT, Owens J, Crouch M, Stahl J, Carskadon MA. Neurobehavioral performance of residents after heavy night call vs after alcohol ingestion. JAMA. 2005;294(9):1025-1033.
13. Waters F, Bucks RS. Neuropsychological effects of sleep loss: implication for neuropsychologists. J Int Neuropsychol Soc. 2011;4:1-16.
14. Van Dongen HP, Maislin G, Mullington JM, Dinges DF The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep. 2003;26(2):117-126.
15. Van Dongen HP, Baynard MD, Maislin G, Dinges DF. Systematic interindividual differences in neurobehavioral impairment from sleep loss: evidence of trait-like differential vulnerability. Sleep. 2004;27(3):423-433.
16. Olson EJ, Drage LA, Auger RR. Sleep deprivation, physician performance, and patient safety. Chest. 2009;136(5):1389-1396.
17. Akerstedt T. Shift work and disturbed sleep/wakefulness. Sleep Med Rev. 1998;2(2):117-128.
18. Cedfeldt AS, Bower EA, English C, Grady-Weliky TA, Girard DE, Choi D. Personal time off and residents' career satisfaction, attitudes and emotions. Med Educ. 2010;44(10):977-974.
19. Nuckols TK, Bhattacharya J, Wolman DM, Ulmer C, Escarce JJ. Cost implications of reduced work hours and workloads for resident physicians. N Engl J Med. 2009;360(21):2202-2215.
20. Papp KK, Stoller EP, Sage P, et al. The effects of sleep loss and fatigue on resident-physicians: a multi-institutional, mixed-method study. Acad Med. 2004;79(5):394-406.
21. Tafflnder NJ, McManus IC, Gul Y, Russell RC, Darzi A. Effect of sleep deprivation on surgeons' dexterity on laparoscopy simulator. Lancet. 1998;352(9135):1191.
22. Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J. Laparoscopic performance after one night on call in a surgical department: prospective study. BMJ. 2001;323(7323):1222-1223.
23. Lingenfelser T, Kaschel R, Weber A, Zaiser-Kaschel H, Jakober B, Küper J. Young hospital doctors after night duty: their task-specific cognitive status and emotional condition. Med Educ. 1994;28(6):566-572.
24. Rosen IM, Bellini LM, Shea JA. Sleep behaviors and attitudes among internal medicine housestaff in a U.S. university-based residency program. Acad Med. 2004;79(5):407-416.
25. Ayas NT, Barger LK, Cade BE, et al. Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA. 2006;296(9):1055-1062.
26. Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep. 2005;28(11):1392-1402.
27. Baldwin DC Jr, Daugherty SR. Sleep deprivation and fatigue in residency training: results of a national survey of first- and second-year residents. Sleep. 2004;27(2):217-223.
28. Leonard C, Fanning N, Attwood J, Buckley M. The effect of fatigue, sleep deprivation and onerous working hours on the physical and mental wellbeing of pre-registration house officers. Ir J Med Sci. 1998;167(1):22-25.
29. McBeth BD, McNamara RM, Ankel FK, et al. Modafinil and zolpidem use by emergency medicine residents. Acad Emerg Med. 2009;16(12):1311-1317.
30. Barger LK, Cade BE, Ayas NT, et al; Harvard Work Hours, Health, and Safety Group. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005;352(2):125-134.
31. Marcus CL, Loughlin GM. Effect of sleep deprivation on driving safety in housestaff. Sleep. 1996;19(10):763-766.
32. Steele MT, Ma OJ, Watson WA, Thomas HA Jr, Muelleman RL. The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med. 1999;6(10):1050-1053.
33. Segawa K, Nakazawa S, Tsukamoto Y, et al. Peptic ulcer is prevalent among shift workers. Dig Dis Sci. 1987;32(5):449-453.
34. Taylor PJ, Pocock SJ. Mortality of shift and day workers 1956-68. Br J Ind Med. 1972;29(2):201-207.
35. Alshekhlee A, Walbert T, DeGeorgia M, Preston DC, Furlan AJ. The impact of Accreditation Council for Graduate Medical Education duty hours, the July phenomenon, and hospital teaching status on stroke outcomes. J Stroke Cerebrovasc Dis. 2009;18(3):232-238.
36. Nurminen T. Shift work and reproductive health. Scand J Work Environ Health. 1998;24(suppl 3):28-34.
37. Prasad M, Iwashyna TJ, Christie JD, et al. Effect of work-hours regulations on intensive care unit mortality in United States teaching hospitals. Crit Care Med. 2009;37(9):2564-2569.
38. Brandenberger J, Kahol K, Feinstein AJ, Ashby A, Smith M, Ferrara JJ. Effects of duty hours and time of day on surgery resident proficiency. Am J Surg. 2010;200(6):814-818; discussion 818-819.
39. Gander P, Purnell H, Garden A, Woodward A. Work patterns and fatigue-related risk among junior doctors. Occup Environ Med. 2007;64(11):733-738.
40. Tabrizian P, Rajhbeharrysingh U, Khaitov S, Divino CM. Persistent noncompliance with the work-hour regulation. Arch Surg. 2011;146(2):175-178.
41. Volpp KG, Rosen AK, Rosenbaum PR, et al. Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA. 2007;298(9):984-992.
42. Horwitz LI, Kosiborod M, Lin Z, Krumholz HM. Changes in outcomes for internal medicine inpatients after work-hour regulations. Ann Intern Med. 2007;147(2):97-103.
43. Shetty KD, Bhattacharya J. Changes in hospital mortality associated with residency work-hour regulations. Ann Intern Med. 2007;147(2):73-80.
44. Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA. 2009;302(14):1565-1572.
45. Yaghoubian A, De Virgilio C, Destro L, Kaji AH, Putnam B, Neville AL. Optimal deployment of trauma personnel in the 80-hour work week era based on peak times of trauma patient arrival. Am Surg. 2010;76(10):1039-1042.
46. Landrigan CP, Barger LK, Cade BE, Ayas NT, Czeisler CA. Interns' compliance with Accreditation Council for Graduate Medical Education work-hour limits. JAMA. 2006;296(9):1063-1070.
47. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838-1848.
48. Directive 2003/88/EC of the European Parliament and of the Council of 4 November 2003 concerning certain aspects of the organisation of working time. http://eur-lex.europa.eu/smartapi/cgi/sga_doc?smartapi!celexapi!prod!CELEXnumdoc&lg=en&numdoc=32003L0088&model=guichett. Accessed June 28, 2012.
49. Cappuccio FP, Bakewell A, Taggart FM, et al; Warwick EWTD Working Group. Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. QJM. 2009;102(4):271-282.
50. Salim A, Teixeira PG, Chan L, et al. Impact of the 80-hour workweek on patient care at a level I trauma center. Arch Surg. 2007;142(8):708-712; discussion 712-714.
51. Baldwin K, Namdari S, Donegan D, Kamath AF, Mehta S. Early effects of resident work-hour restrictions on patient safety: a systematic review and plea for improved studies. J Bone Joint Surg Am. 2011;93(2):e5.1-e5.9.
52. Moonesinghe SR, Lowery J, Shahi N, Millen A, Beard JD. Impact of reduction in working hours for doctors in training on postgraduate medical education and patients' outcomes: systematic review. BMJ. 2011;342:d1580.
53. Parthasarathy S, Hettiger K, Budhiraja R, Sullivan B. Sleep and well-being of ICU housestaff. Chest. 2007;131(6):1685-1693.
54. Dozois EJ, Holubar SD, Tsikitis VL, et al. Perceived impact of the 80-hour workweek: five years later. J Surg Res. 2009;156(1):3-15.
55. Howard SK, Gaba DM, Rosekind MR, Zarcone VP. The risks and implications of excessive daytime sleepiness in resident physicians. Acad Med. 2002;77(10):1019-1025.
56. Arora V, Dunphy C, Chang VY, Ahmad F, Humphrey HJ, Meltzer D. The effects of on-duty napping on intern sleep time and fatigue. Ann Intern Med. 2006;144(11):792-798.
57. Arora VM, Georgitis E, Woodruff JN, Humphrey HJ, Meltzer D. Improving sleep hygiene of medical interns: can the sleep, alertness, and fatigue education in residency program help? Arch Intern Med. 2007;167(16):1738-1744.
58. Goitein L, Shanafelt TD, Wipf JE, Slatore CG, Back AL. The effects of work-hour limitations on resident well-being, patient care, and education in an internal medicine residency program. Arch Intern Med. 2005;165(22):2601-2606.
59. Myers JS, Bellini LM, Morris JB, Slatore CG, Back AL. Internal medicine and general surgery residents' attitudes about the ACGME duty hours regulations: a multicenter study. Acad Med. 2006;81(12):1052-1058.
60. Adler MD, Vozenilek JA, Trainor JL, et al. Comparison of checklist and anchored global rating instruments for performance rating of simulated pediatric emergencies. Simul Healthc. 2011;6(1):18-24.
61. Cohen-Gadol AA, Piepgras DG, Krishnamurthy S, Fessler RD. Resident duty hours reform: results of a national survey of the program directors and residents in neurosurgery training programs. Neurosurgery. 2005;56(2):398-403; discussion 398-403.
62. Berger WG, Gibson SW, Krupinski EA, Morais JD. Proposed ACGME change in length of radiology residency training before independent call: results of a survey of program directors and chief residents. J Am Coll Radiol. 2007;4(9):595-601.
63. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2): 186-194.
64. Horwitz LI, Moin T, Krumholz HM, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755-1760.
65. Kairys JC, McGuire K, Crawford AG, Yeo CJ. Cumulative operative experience is decreasing during general surgery residency: a worrisome trend for surgical trainees? J Am Coll Surg. 2008;206(5):804-811; discussion 811-813.
66. Antiel RM, Thompson SM, Hafferty FW, et al. Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors. Mayo Clin Proc. 2011;86(3):185-191.
67. Blum AB, Raiszadeh F, Shea S, et al. US public opinion regarding proposed limits on resident physician work hours. BMC Med. 2010;8:33.
68. Banks S, Dinges DF Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3(5):519-528.
69. Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A. 2009;106(11):4453-4458.
70. Schernhammer ES, Laden F, Speizer FE, et al. Rotating night shifts and risk of breast cancer in women participating in the nurses' health study. J Natl Cancer Inst. 2001;93(20):1563-1568.
71. Hutter MM, Kellogg KC, Ferguson CM, Abbott WM, Warshaw AL. The impact of the 80-hour resident workweek on surgical residents and attending surgeons. Ann Surg. 2006;243(6):864-871; discussion 871-875.
72. McElearney ST, Saalwachter AR, Hedrick TL, Pruett TL, Sanfey HA, Sawyer RG. Effect of the 80-hour work week on cases performed by general surgery residents. Am Surg. 2005;71(7):552-555; discussion 555-556.
73. Kelly RJ Jr, Senkowski CK. Effect of the night float system on operative case volume for senior surgical residents. J Surg Educ. 2009;66(6): 314-318.