Cited by 929Sleep and Work-Related FatigueHospital Admissions and OutcomesHealthcare professionals’ stress and burnout

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Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns

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Barger, Laura K., Cade, Brian E., Ayas, Najib T., Cronin, John W., Rosner, Bernard, Speizer, Frank E., Czeisler, Charles A.·2005·New England Journal of Medicine

DOI 10.1056/nejmoa041401

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Abstract

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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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)
ORCID: Barger, Laura K.
Cade, Brian E.
Ayas, Najib T.
Rosner, Bernard
Czeisler, Charles A.
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
DOI: 10.1056/nejmoa041401
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

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Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns

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