RT Journal Article
SR Electronic
T1 Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP 321
OP 329
DO 10.1503/cmaj.140752
VO 187
IS 5
A1 Christopher S. Parshuram
A1 Andre C.K.B. Amaral
A1 Niall D. Ferguson
A1 G. Ross Baker
A1 Edward E. Etchells
A1 Virginia Flintoft
A1 John Granton
A1 Lorelei Lingard
A1 Haresh Kirpalani
A1 Sangeeta Mehta
A1 Harvey Moldofsky
A1 Damon C. Scales
A1 Thomas E. Stewart
A1 Andrew R. Willan
A1 Jan O. Friedrich
A1 ,
YR 2015
UL http://www.cmaj.ca/content/187/5/321.abstract
AB Background: Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care.Methods: Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents’ physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed.Results: We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents’ sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents’ somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents’ knowledge and decision-making worst with the 16-hour schedule.Interpretation: Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents’ symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. Trial registration: ClinicalTrials.gov, no. NCT00679809.