Effect of a Protected Sleep Period on Hours Slept During Extended Overnight In-hospital Duty Hours Among Medical Interns: A Randomized Trial
Open accessAbstract
CONTEXT: A 2009 Institute of Medicine report recommended protected sleep periods for medicine trainees on extended overnight shifts, a position reinforced by new Accreditation Council for Graduate Medical Education requirements. OBJECTIVE: To evaluate the feasibility and consequences of protected sleep periods during extended duty. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled trial conducted at the Philadelphia VA Medical Center medical service and Oncology Unit of the Hospital of the University of Pennsylvania (2009-2010). Of the 106 interns and senior medical students who consented, 3 were not scheduled on any study rotations. Among the others, 44 worked at the VA center, 16 at the university hospital, and 43 at both. INTERVENTION: Twelve 4-week blocks were randomly assigned to either a standard intern schedule (extended duty overnight shifts of up to 30 hours; equivalent to 1200 overnight intern shifts at each site), or a protected sleep period (protected time from 12:30 AM to 5:30 AM with handover of work cell phone; equivalent to 1200 overnight intern shifts at each site). Participants were asked to wear wrist actigraphs and complete sleep diaries. MAIN OUTCOME MEASURES: Primary outcome was hours slept during the protected period on extended duty overnight shifts. Secondary outcome measures included hours slept during a 24-hour period (noon to noon) by day of call cycle and Karolinska sleepiness scale. RESULTS: For 98.3% of on-call nights, cell phones were signed out as designed. At the VA center, participants with protected sleep had a mean 2.86 hours (95% CI, 2.57-3.10 hours) of sleep vs 1.98 hours (95% CI, 1.68-2.28 hours) among those who did not have protected hours of sleep (P < .001). At the university hospital, participants with protected sleep had a mean 3.04 hours (95% CI, 2.77-3.45 hours) of sleep vs 2.04 hours (95% CI, 1.79-2.24) among those who did not have protected sleep (P < .001). Participants with protected sleep were significantly less likely to have call nights with no sleep: 5.8% (95% CI, 3.0%-8.5%) vs 18.6% (95% CI, 13.9%-23.2%) at the VA center (P < .001) and 5.9% (95% CI, 3.1%-8.7%) vs 14.2% (95% CI, 9.9%-18.4%) at the university hospital (P = .001). Participants felt less sleepy after on-call nights in the intervention group, with Karolinska sleepiness scale scores of 6.65 (95% CI, 6.35-6.97) vs 7.10 (95% CI, 6.85-7.33; P = .01) at the VA center and 5.91 (95% CI, 5.64-6.16) vs 6.79 (95% CI, 6.57-7.04; P < .001) at the university hospital. CONCLUSIONS: For internal medicine services at 2 hospitals, implementation of a protected sleep period while on call resulted in an increase in overnight sleep duration and improved alertness the next morning. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00874510.
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- Authors
- Volpp, K. G., Shea, J. A., Small, D. S., Basner, M., Zhu, J., Norton, L., Ecker, A., Novak, C., Bellini, L. M., Dine, C. J., Mollicone, D. J., & Dinges, D. F.
- Affiliations
- Philadelphia VA Medical Center (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2012-12-05
- Volume
- 308
- Issue
- 21
- Pages
- 2208
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC3600853
- OpenAlex
- W2083569689
- Cited by
- 44
- References
- 33
- Citations by year
- 2026: 2 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 2 · 2015: 4 · 2014: 11 · 2013: 1 · 2012: 1
- FWCI
- 7.30
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (NR004281, R01NR004281)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- medical interns, sleep deprivation, sleep duration, sleepiness, Karolinska Sleepiness Scale, graduate medical education, Accreditation Council for Graduate Medical Education, medical students, actigraphy, sleep diary, physician well-being
- MeSH terms
- Adult, Female, Hospitals, University, Hospitals, Veterans, Humans, Internship and Residency, Male, Personnel Staffing and Scheduling, Sleep, Students, Medical, Time Factors, Philadelphia, Workload, Cell Phone, Young Adult, Actigraphy
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