Effects on resident work hours, sleep duration, and work experience in a randomized order safety trial evaluating resident-physician schedules (ROSTERS)
Authors: Barger Laura K , Sullivan Jason P , Blackwell Terri , O’Brien Conor S , St. Hilaire Melissa A , Rahman Shadab A , Phillips Andrew J K , Qadri Salim , Wright Kenneth P , Segar Jeffrey L , McGuire John K , Vitiello Michael V , de la Iglesia Horacio O , Poynter Sue E , Yu Pearl L , Zee Phyllis , Sanderson Amy L , Halbower Ann C , Lockley Steven W , Landrigan Christopher P , Stone Katie L , Czeisler Charles A ,   ROSTERS Study Group, Barger Laura K , Czeisler Charles A , St Hilaire Melissa A , Klerman Elizabeth B , Landrigan Christopher P , Lockley Steven W , O’Brien Conor S , Phillips Andrew J K , Qadri Salim , Rahman Shadab A , Sullivan Jason P , Viyaran Natalie C , Blackwell Terri , Kriesel Dana R , Stone Katie L , Czaja Angela S , Halbower Ann C , Rosenberg Adam , Wright Kenneth P , Cress Gretchen , Erkonen Gwen E , Segar Jeffrey L , Armstrong Lindsey B , Albert Ben D , Bressler Erin A , Daniel Dennis , Landrigan Christopher P , Podd Bradley S , Sanderson Amy L , Sectish Theodore C , Upchurch Patrick A , Wolbrink Traci A , Poynter Sue E , Carver Jeannean , Yu Pearl L , Batra Maneesh , Farris Reid W D , la Iglesia Horacio O de , McGuire John K , Vitiello Michael V , Zee Phyllis C 
Published: May 2019

Study Objectives

We compared resident physician work hours and sleep in a multicenter clustered-randomized crossover clinical trial that randomized resident physicians to an Extended Duration Work Roster (EDWR) with extended-duration (≥24 hr) shifts or a Rapidly Cycling Work Roster (RCWR), in which scheduled shift lengths were limited to 16 or fewer consecutive hours.

Methods

Three hundred two resident physicians were enrolled and completed 370 1 month pediatric intensive care unit rotations in six US academic medical centers. Sleep was objectively estimated with wrist-worn actigraphs. Work hours and subjective sleep data were collected via daily electronic diary.

Results

Resident physicians worked fewer total hours per week during the RCWR compared with the EDWR (61.9 ± 4.8 versus 68.4 ± 7.4, respectively; p < 0.0001). During the RCWR, 73% of work hours occurred within shifts of ≤16 consecutive hours. In contrast, during the EDWR, 38% of work hours occurred on shifts of ≤16 consecutive hours. Resident physicians obtained significantly more sleep per week on the RCWR (52.9 ± 6.0 hr) compared with the EDWR (49.1 ± 5.8 hr, p < 0.0001). The percentage of 24 hr intervals with less than 4 hr of actigraphically measured sleep was 9% on the RCWR and 25% on the EDWR (p < 0.0001).

Conclusions

RCWRs were effective in reducing weekly work hours and the occurrence of >16 consecutive hour shifts, and improving sleep duration of resident physicians. Although inclusion of the six operational healthcare sites increases the generalizability of these findings, there was heterogeneity in schedule implementation. Additional research is needed to optimize scheduling practices allowing for sufficient sleep prior to all work shifts.

Clinical Trial: Multicenter Clinical Trial of Limiting Resident Work Hours on ICU Patient Safety (ROSTERS), https://clinicaltrials.gov/ct2/show/NCT02134847