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Cited by 104Hospital Admissions and OutcomesSleep and Work-Related FatigueHealthcare professionals’ stress and burnout

Patient safety, resident well-being and continuity of care with different resident duty schedules in the intensive care unit: a randomized trial

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Parshuram, Christopher S., Amaral, Andre C.K.B., Ferguson, Niall D., Baker, G. Ross, Etchells, Edward E., Flintoft, Virginia, Granton, John, Lingard, Lorelei +7 more·2015·Canadian Medical Association Journal
DOI 10.1503/cmaj.140752PMC PMC4361104
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Abstract

BACKGROUND: Shorter resident duty periods are increasingly mandated to improve patient safety and physician well-being. However, increases in continuity-related errors may counteract the purported benefits of reducing fatigue. We evaluated the effects of 3 resident schedules in the intensive care unit (ICU) on patient safety, resident well-being and continuity of care. METHODS: Residents in 2 university-affiliated ICUs were randomly assigned (in 2-month rotation-blocks from January to June 2009) to in-house overnight schedules of 24, 16 or 12 hours. The primary patient outcome was adverse events. The primary resident outcome was sleepiness, measured by the 7-point Stanford Sleepiness Scale. Secondary outcomes were patient deaths, preventable adverse events, and residents' physical symptoms and burnout. Continuity of care and perceptions of ICU staff were also assessed. RESULTS: We evaluated 47 (96%) of 49 residents, all 971 admissions, 5894 patient-days and 452 staff surveys. We found no effect of schedule (24-, 16- or 12-h shifts) on adverse events (81.3, 76.3 and 78.2 events per 1000 patient-days, respectively; p = 0.7) or on residents' sleepiness in the daytime (mean rating 2.33, 2.61 and 2.30, respectively; p = 0.3) or at night (mean rating 3.06, 2.73 and 2.42, respectively; p = 0.2). Seven of 8 preventable adverse events occurred with the 12-hour schedule (p = 0.1). Mortality rates were similar for the 3 schedules. Residents' somatic symptoms were more severe and more frequent with the 24-hour schedule (p = 0.04); however, burnout was similar across the groups. ICU staff rated residents' knowledge and decision-making worst with the 16-hour schedule. INTERPRETATION: Our findings do not support the purported advantages of shorter duty schedules. They also highlight the trade-offs between residents' symptoms and multiple secondary measures of patient safety. Further delineation of this emerging signal is required before widespread system change. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT00679809.

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  • Of the included studies, 20 targeted individual interventions and 2 targeted structural interventions.

    “A total of 22 studies were included in our analysis, with 20 studies targeting individual interventions and 2 studies targeting structural interventions.”

    From Prevention of burnout syndrome in physicians: a systematic review and meta-analysis (2026) · cites this paper as [18]

  • Organizational interventions showed no statistically significant association with any burnout domain (EE, DP, PA).

    “In organizational intervention studies [44, 45, 47–49, 73, 76], pooling of post-intervention intervention Cohen’s d SMD yielded non-statistically significant resulted in all outcomes, EE (-0.22, 95% CI -0.47 to 0.04, p = 0.10, I2 = 62.6%) (Fig. 3A), DP (-0.15, 95% CI -0.38 to 0.08, p = 0.21, I2 = 53.0%) (Fig. 3B), and PA (0.12, 95% CI -0.01 to 0.25, p = 0.07; I2 = 0%) (Fig. 3C).”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [45]

  • In the organizational work-hour intervention subgroup, there was no significant post-intervention effect across all outcome domains: EE -0.20 (95% CI -0.58 to 0.17, p = 0.29, I2 = 67.1%), DP -0.16 (95% CI -0.48 to 0.16, p = 0.33, I2 = 55.8%), and PA 0.04 (95% CI -0.12 to 0.20, p = 0.60, I2 = 0%).

    “Subgroup analyses revealed no post-intervention Cohen’s d SMD in work-hour interventions [44, 45, 47, 73, 76] across all outcome domains: EE (-0.20, 95% CI -0.58 to 0.17, p = 0.29, I2 = 67.1%), DP (-0.16, 95% CI -0.48 to 0.16, p = 0.33, I2 = 55.8%), and PA (0.04, 95% CI -0.12 to 0.20, p = 0.60, I2 = 0%).”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [45]

  • Outcome measurements were conducted using various versions of the validated Maslach Burnout Inventory (MBI): 26 studies used the 22-item MBI, 5 used the 9-item MBI, 1 used the 20-item Dutch version, and 1 used the 16-item MBI.

    “Outcome measurements were conducted using various versions of the validated MBI. Specifically, 26 studies (78.7%) used the 22-item MBI [44, 45, 47–49, 51, 52, 54, 56, 58, 60–65, 67, 68, 70–76], 5 studies (15.2%) employed the 9-item MBI [50, 53, 55, 59, 69], 1 study (3.0%) used the 20-item Dutch version of the MBI [57], and 1 study (3.0%) utilized the 16-item MBI [66].”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [45]

  • Eight studies (72.7%) were categorized as high risk of bias in the second or third domain due to naive per protocol analysis from complete cases at the end of the studies.

    “Also, 8 studies [45, 51, 52, 57, 63, 64, 74], comprising 72.7% of the total, were categorized as high risk of bias in the second or third domain due to naive per protocol analysis from complete cases at the end of the studies.”

    From Individual and organizational interventions to reduce burnout in resident physicians: a systematic review and meta-analysis (2024) · cites this paper as [45]

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Authors
Parshuram, C. S., Amaral, A. C. K. B., Ferguson, N. D., Baker, G. R., Etchells, E. E., Flintoft, V., Granton, J., Lingard, L., Kirpalani, H., Mehta, S., Moldofsky, H., Scales, D. C., Stewart, T. E., Willan, A. R., & Friedrich, J. O.
Affiliations
  • University of Toronto (CA)
  • St. Michael's Hospital (CA)
  • Sunnybrook Health Science Centre (CA)
  • University Health Network (CA)
  • Western University (CA)
  • Children's Hospital of Philadelphia (US)
  • Mount Sinai Hospital (CA)
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Joule Inc.
Published
2015-02-09
Volume
187
Issue
5
Pages
321-329
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.140752
PMC
PMC4361104
OpenAlex
W2118909144
Cited by
104
References
51
Citations by year
2026: 3 · 2025: 9 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 13 · 2019: 13 · 2018: 9 · 2017: 13 · 2016: 11 · 2015: 8
FWCI
13.31
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (84525)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
  • Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
Keywords
resident fatigue, patient safety, continuity of care, preventable adverse events, resident well-being, burnout, sleepiness, shift length, somatic symptoms
MeSH terms
Adult, Aged, Aged, 80 and over, Attitude of Health Personnel, Continuity of Patient Care, Fatigue, Female, Humans, Intensive Care Units, Internship and Residency, Male, Middle Aged, Ontario, Outcome and Process Assessment, Health Care, Personnel Staffing and Scheduling, Physicians, Work Schedule Tolerance, Workload, Medical Errors, Patient Safety

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