Clinical Activity During Night-shift: an Ecological Study
Condition: Nightshift Work; Handoff Sessions; Stress, Psychological; Regret; Sleep
MeSH terms: Stress, Psychological
Study type: Observational

Summary: 
      A convenient sample of internal medicine residents will be observed during their nightshift
      work in the wards of the department of internal medicine of a university hospital. The
      epidemiology of night calls and emergencies, including incidence, causes, management, and
      prognosis, will be assessed prospectively. The impact of nightshift work on sleep, stress,
      quality of life, regrets, and general well being of the residents observed will be measured
      through completion of validated questionnaires. Quality of handoff sessions will also be
      assessed.
    

Detailed description: 
      Various medical problems of patients admitted to an internal medicine ward can worsen during
      the stay. Furthermore, new, unidentified problems can develop (complications, medication
      errors, delirium, acute anxiety or pain, etc). During evenings, nights and week-ends,
      emergent needs of hospitalized patients are usually cared for by physicians in-training, who
      are in charge of a large number of patients. Hence, physicians should have a wide range of
      medical knowledge and procedural skills and know how acute problems are dealt with in the
      unique environment of the healthcare institution. Training physicians should also be able to
      obtain information and counseling efficiently, either from clinical guidelines, senior
      supervisors, or specialists.

      These requirements may represent a significant stress for training physicians and may have a
      major impact on their health, quality of life, and finally on the quality of inpatient care.
      Nightshift work may lead later to a high burden of regrets among caregivers.

      Better knowledge of training needs, organization features, coping strategies, and regrets
      associated with nightshift duty are important to prepare training physicians to that
      demanding and necessary task. Understanding of the epidemiology of night-shift ward
      emergencies could provide guidance concerning the required level of staffing and training of
      the responding medical team.

      Furthermore, efficient transmission of information between day and night staff (so-called
      handoffs) is a difficult yet important part of care. Systematic observation of handoff
      sessions between physicians before and after nightshifts may enhance previous knowledge on
      key components of these topics.

      The investigators will evaluate the incidence causes, and prognosis of night-shift
      emergencies in internal medicine wards by direct observation of the nightshift work of a
      convenient sample of internal medicine residents. By the means of before-and-after shift
      completion of various validated questionnaires, the investigators will explore quantitatively
      and qualitatively the physiological and psychological impact on nightshift work for
      physicians in training.

      The planned study will also provide qualitative and quantitative data concerning handoffs
      session, and the repercussions on night shift emergencies management.
    

Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        see above