Connect
MJA
MJA

Safer hours for doctors and improved safety for patients

Dev A S Kevat, Peter A Cameron, Andrew R Davies, Chris P Landrigan and Shantha W Rajaratnam
Med J Aust 2014; 200 (7): . || doi: 10.5694/mja13.10412
Published online: 21 April 2014

Abstract

  • An increasing weight of evidence is demonstrating that sleep deprivation and circadian rhythm disruption in doctors are associated with human error and harm to both patients and doctors.

  • The increasing junior doctor workforce entering the hospital system in Australia provides a rare opportunity for workplace and roster reforms.

  • There are cultural, educational and industrial challenges to reforming working hours.

  • Any changes should be evidence-based and monitored to ensure that training for junior doctors and patient care are not compromised.


  • 1 Monash University, Melbourne, VIC.
  • 2 Royal Brisbane and Women’s Hospital, Brisbane, QLD.
  • 3 Harvard University, Boston, Mass, USA.


Correspondence: dev.kevat@monash.edu

Competing interests:

Chris Landrigan has received honoraria from the US Committee of Interns and Residents (CIR) for grand rounds presentations on handovers, sleep deprivation and patient safety at CIR member hospitals. Shantha Rajaratnam has had travel expenses for attendance at scientific conferences reimbursed by Vanda Pharmaceuticals; is Immediate Past President of the Australasian Sleep Association; has performed consultancy work for the National Transport Commission, EdanSafe, Philips Respironics and the Australian Workers Union; and his institution has received research grants from the ResMed Foundation, Cephalon, Philips Respironics, Takeda Pharmaceuticals, and Vanda Pharmaceuticals. No grants were made for research or writing of this article.

  • 1. Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA 2009; 302: 1565-1572.
  • 2. 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: 1838-1848.
  • 3. Ayas NT, Barger LK, Cade BE, et al. Extended work duration and the risk of self-reported percutaneous injuries in interns. JAMA 2006; 296: 1055-1062.
  • 4. Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005; 352: 125-134.
  • 5. Australian Government Department of Health. Medical Training Review Panel: fifteenth report. Canberra: Commonwealth of Australia, 2012. http://www. health.gov.au/internet/publications/publishing.nsf/Content/work-pubs-mtrp-15-toc (accessed Dec 2013).
  • 6. Philibert I. Sleep loss and performance in residents and nonphysicians: a meta-analytic examination. Sleep 2005; 28: 1392-1402.
  • 7. Levine AC, Adusumilli J, Landrigan CP. Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review. Sleep 2010; 33: 1043-1053.
  • 8. Rosenbaum L, Lamas D. Residents’ duty hours — toward an empirical narrative. N Engl J Med 2012; 367: 2044-2049.
  • 9. European Parliament and Council. Working time directive. 2003/88/EC. http://ec.europa.eu/social/main.jsp?catId=706&langId=en&intPageId=205 (accessed Oct 2013).
  • 10. Gohar A, Adams A, Gertner E, et al. Working memory capacity is decreased in sleep-deprived internal medicine residents. J Clin Sleep Med 2009; 5: 191-197.
  • 11. Lockley SW, Cronin JW, Evans EE, et al. Effect of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med 2004; 351: 1829-1837.
  • 12. Stikic M, Johnson RR, Levendowski DJ, et al. EEG-derived estimators of present and future cognitive performance. Front Hum Neurosci 2011; 5: 70.
  • 13. Barger LK, Lockley SW, Rajaratnam SM, Landrigan CP. Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Curr Neurol Neurosci Rep 2009; 9: 155-164.
  • 14. Gordon JA, Alexander EK, Lockley SW, et al. Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical interns. Acad Med 2010; 85: 1583-1588.
  • 15. Klerman EB, Dijk DJ. Interindividual variation in sleep duration and its association with sleep debt in young adults. Sleep 2005; 28: 1253-1259.
  • 16. 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: 117-126.
  • 17. Dawson D, Reid K. Fatigue, alcohol and performance impairment. Nature 1997; 388: 235.
  • 18. Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond) 2003; 53: 95-101.
  • 19. Cappuccio FP, Bakewell A, Taggart FM, et al. 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: 271-282.
  • 20. Levine AC, Adusumilli J, Landrigan CP. Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review. Sleep 2010; 33: 1043-1053.
  • 21. Australian Medical Association. Safe hours = safe patients. AMA safe hours audit 2006. Canberra: AMA, 2006. https://ama.com.au/system/files/node/4051/Safe_Hours_Report.pdf (accessed Dec 2013).
  • 22. Australian Medical Association. AMA safe hours audit 2011. Canberra: AMA, 2011. https://ama.com.au/ama-safe-hours-audit-2011 (accessed Dec 2013).
  • 23. Folkard S. Do permanent night workers show circadian adjustment? A review based on the endogenous melatonin rhythm. Chronobiol Int 2008; 25: 215-224.
  • 24. Marcus L, Liew D, Knott J. The effect of nightshift on emergency registrars’ clinical skills. Emerg Med Australas 2010; 22: 211-215.
  • 25. National Research Council. Resident duty hours: enhancing sleep, supervision, and safety. Washington, DC: The National Academies Press, 2009. http://www.iom.edu/Reports/2008/Resident-Duty-Hours-Enhancing- Sleep-Supervision-and-Safety.aspx (accessed Dec 2013).
  • 26. Royal Australasian College of Surgeons. Standards for safe working hours and conditions for fellows, surgical trainees and international medical graduates. Melbourne: RACS, 2007. www.surgeons.org/media/17658/SafeHours_small_final_printout.pdf (accessed Nov 2013).
  • 27. Temple J. Time for training: a review of the impact of the European Working Time Directive on the quality of training. 2010. http://www.mee.nhs.uk/pdf/JCEWTD_Final%20report.pdf (accessed Nov 2013).
  • 28. Queensland Industrial Relations Commission. Medical Officers’ (Queensland Health) Certified Agreement (No. 3) 2012. CA/2012/546. http://www.qirc.qld. gov.au/resources/pdf/certified_agreements/cert_agreements/2012/ca546_2012.pdf (accessed Oct 2013).
  • 29. Wysocki AP, McGowan B. Revising the surgical registrar on-call roster. ANZ J Surg 2010; 80: 490-494.
  • 30. Australian Council for Safety and Quality in Health Care. Clinical handover and patient safety — literature review report. 2005. http://www.safetyandquality. gov.au/wp-content/uploads/2012/01/clinhovrlitrev.pdf (accessed Feb 2014).
  • 31. Health Workforce Australia. Health workforce 2025. Volume 3: medical specialties. Adelaide: HWA, 2012. https://www.hwa.gov.au/sites/uploads/HW2025_V3_FinalReport20121109.pdf (accessed Oct 2013).
  • 32. Beckett DJ, Gordon CF, Paterson R, et al. Improvement in out-of-hours outcomes following the implementation of Hospital at Night. QJM 2009; 102: 539-546.
  • 33. Australian Medical Association. National code of practice: hours of work, shiftwork and rostering for hospital doctors. Canberra: AMA, 2005. https://ama.com.au/system/files/node/3756/National_Code_of_Practice_January_2005.pdf (accessed Dec 2013).
  • 34. O’Grady G, Harper, S, Loveday B, et al. Appropriate working hours for surgical training according to Australasian trainees. ANZ J Surg 2012; 82: 225-229.

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.