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Protected Sleep For Medical Interns Improves Alertness During Extended Overnight Hospital Shifts

INTRO:The working life of a medical intern or resident is fast paced and includes long hours. Many get very little to no sleep while on duty. Last year duty hour standards for first year interns were revised to a limit of no more than 16 continuous hours. This was to help reduce the risk of fatigue-related errors when working a shift of up to 30 hours. A new study looked at whether protected sleep periods for interns on extended duty overnight shifts was feasible and would improve alertness. Catherine Dolf explains in this week’s JAMA Report.

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Dr. Faust walking outside, looking at computer with colleague

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DR. HILARY FAUST COMES FROM A FAMILY OF PHYSICIANS AND IS WELL AWARE THAT SLEEP IS A PREMIUM, BUT IMPORTANT, WHILE SHE COMPLETES HER MEDICAL TRAINING.

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SOT/FULL Super @:07 Hilary Faust, M.D., – University of Pennsylvania Health System Runs:12

“When I do rotations now where I’m doing 30 hour shifts getting an hour of sleep or even half an hour of sleep makes a huge difference and I do feel much better after that.”

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Dr. Faust and colleagues walking on hospital floor

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HOWEVER, SLEEP IS NOT A GUARANTEE ON THESE SHIFTS.

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SOT/FULL Super@:22 David F. Dinges, Ph.D., – University of Pennsylvania, Perelman School of Medicine Runs:05

“There’s a large amount of research showing that sleep deprivation can adversely affect performance and safety.”

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SOT/FULL Super@ :27 Kevin G. Volpp, M.D., Ph.D., – Philadelphia VA Medical Center/U of Pennsylvania Runs:11

“There have been concerns for a long time that having prolonged periods of wakefulness could really contribute to impaired performance among interns.”

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Dr. Volpp and Dr. Dinges walking down staircase, medical intern going into call room, taking off lab coat, going to sleep, interns and residents walking on hospital floor

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DOCTORS KEVIN VOLPP FROM THE PHILADELPHIA V-A MEDICAL CENTER AND DAVID DINGES, BOTH FROM THE UNIVERSITY OF PENNSYLVANIA PERELMAN SCHOOL OF MEDICINE AND CO-AUTHORS, CONDUCTED A RANDOMIZED TRIAL WITH A GROUP OF MEDICAL INTERNS WHO WORKED AT U-PENN AND THE PHILADELPHIA V-A. EVERY OTHER MONTH ONE GROUP HAD PROTECTED SLEEP PERIODS DURING THEIR SHIFT. THEY TURNED IN PHONES AND PAGERS TO THE RESIDENTS ON CALL. THE OTHER GROUP WORKED A STANDARD SCHEDULE AND ONLY SLEPT IF TIME ALLOWED.

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SOT/FULL Super@ 1:02 Kevin G. Volpp, M.D., Ph.D., – Philadelphia VA Medical Center/U of Pennsylvania Runs:12

“The average amounts interns slept increased by about 50 percent in the months in which interns had a protected sleep period, from about two hours a night to about 3 hours a night.”

(Video covering 2nd half of the bite: intern in call room sleeping)

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JAMA COVER

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THE STUDY APPEARS IN A THEME ISSUE ON MEDICAL EDUCATION IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

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SOT/FULL Super@ 1:23 David F. Dinges, Ph.D., – University of Pennsylvania, Perelman School of Medicine Runs:10

“They slept earlier, longer and less disturbed. We didn’t completely give them a full night’s sleep but even the three hours, the 50 percent more sleep they got was beneficial.”

(Video covering 1st part of bite: intern sleeping)

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SOT/FULL Super@ 1:30 Kevin G. Volpp, M.D., Ph.D., – Philadelphia VA Medical Center/U of Pennsylvania Runs:07

“People had higher cognitive performance on the mornings following protected sleep periods.”

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Dr. Faust looking at computer discussing a case with colleague

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INTERN PARTICIPATION WAS KEY AND RESEARCHERS SAY MORE THAN 98 PERCENT OF THE TIME INTERNS TURNED OVER THEIR CELL PHONES TO THE COVERING RESIDENT.

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SOT/FULL Super@ 1:45 David F. Dinges, Ph.D., – University of Pennsylvania, Perelman School of Medicine Runs:13

“Residents are no different than anyone else they need sleep and if you give them a safe, secure protected opportunity to take it where they don’t have to feel guilty or be disturbed repeatedly and they can actually sleep, they will.”

(Video covering 2nd half of bite: intern sleeping, door to call room closing)

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Dr. Faust with colleague

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DR. FAUST SAYS SHE’S BEEN UP SINCE ABOUT 8 A-M YESTERDAY MORNING.

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SOT/FULL Super@2:01 Hilary Faust, M.D., – University of Pennsylvania Health System Runs:04

“I actually feel great right now. I got an hour of sleep last night so I feel pretty good.”

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Dr. Faust on camera

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CATHERINE DOLF, THE JAMA REPORT.

TAG:RESEARCHERS COMPARED MORTALITY AND READMISSION RATES FOR PATIENTS AND FOUND NO DIFFERENCES IN THOSE RATES IN THE GROUP THAT HAD PROTECTED SLEEP AND THOSE WHO DID NOT.