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Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns
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BACKGROUND: Long work hours and work shifts of an extended duration (> or =24 hours) remain a hallmark of medical education in the United States. Yet their effect on health and safety has not been evaluated with the use of validated measures. METHODS: We conducted a prospective nationwide, Web-based survey in which 2737 residents in their first postgraduate year (interns) completed 17,003 monthly reports that provided detailed information about work hours, work shifts of an extended duration, documented motor vehicle crashes, near-miss incidents, and incidents involving involuntary sleeping. RESULTS: The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively. In a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly risk of a crash during the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in which interns worked five or more extended shifts, the risk that they would fall asleep while driving or while stopped in traffic was significantly increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46] and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively). CONCLUSIONS: Extended-duration work shifts, which are currently sanctioned by the Accreditation Council for Graduate Medical Education, pose safety hazards for interns. These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.
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“Sleep loss and night work are associated with reduced alertness and cognitive performance1 and represent a safety challenge for all 24/7 operations, including medicine.2–6”
From Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine (2019) · cites this paper as [3]
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“Subsequent evaluations found that shifts of 24 or more hours were associated with increased odds of fatigue-related medical errors and preventable adverse events (PAEs),3 percutaneous injuries4 and motor vehicle crashes.5”
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Metadata
- Authors
- Barger, L. K., Cade, B. E., Ayas, N. T., Cronin, J. W., Rosner, B., Speizer, F. E., & Czeisler, C. A.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2005-01-13
- Volume
- 352
- Issue
- 2
- Pages
- 125-134
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2112447342
- Cited by
- 928
- References
- 19
- Citations by year
- 2026: 17 · 2025: 26 · 2024: 20 · 2023: 32 · 2022: 36 · 2021: 39 · 2020: 41 · 2019: 42 · 2018: 31 · 2017: 39 · 2016: 45 · 2015: 36 · 2014: 56 · 2013: 42 · 2012: 45
- FWCI
- 88.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Aeronautics and Space Administration (NCC958)
- Brigham and Women's Hospital (T32 HL079010)
- National Space Biomedical Research Institute (NCC 9‐58)
- British Columbia Lung Association
- Agency for Healthcare Research and Quality (F32 HS14130, R01 HS 12032, RO1 HS12032)
- Canadian Institutes of Health Research
- National Heart, Lung, and Blood Institute (T32 HL079010)
- National Institute for Occupational Safety and Health (1 R01 OH07567)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Nursing › Leadership and Management › Hospital Admissions and Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Keywords
- traffic accidents, medical interns, medical residents, near misses, working hours, graduate medical education, occupational safety, sleepiness while driving
- MeSH terms
- Accidents, Traffic, Automobile Driving, Fatigue, Humans, Internship and Residency, Personnel Staffing and Scheduling, Prospective Studies, Surveys and Questionnaires, Risk, Sleep, Sleep Deprivation, United States, Work Schedule Tolerance, Odds Ratio, Workload
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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