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Cited by 149Hospital Admissions and OutcomesSleep and Work-Related FatigueHealthcare professionals’ stress and burnout

The DOI matches its Crossref record; 95 of the 95 references it cites were found in a registry or an index.

Systematic Review: Association of Shift Length, Protected Sleep Time, and Night Float With Patient Care, Residents' Health, and Education

Reed, Darcy A., Fletcher, Kathlyn E., Arora, Vineet M.·2010·Annals of Internal Medicine
DOI 10.7326/0003-4819-153-12-201012210-00010
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Abstract

BACKGROUND: The Accreditation Council for Graduate Medical Education's new duty-hour standards limit interns' shifts to 16 hours and night float to 6 consecutive nights. Protected sleep time (that is, "nap") is strongly encouraged. As duty-hour reforms are implemented, examination of the quality and outcomes of the relevant literature is important. PURPOSE: To systematically review the literature examining shift length, protected sleep time, and night float. DATA SOURCES: MEDLINE, PREMEDLINE, and EMBASE from January 1989 through May 2010. STUDY SELECTION: Studies examined the associations of shift length, protected sleep time, or night float with patient care, resident health, and education outcomes among residents in practice settings. DATA EXTRACTION: Study quality was measured by using the validated Medical Education Research Study Quality Instrument and the U.S. Preventive Services Task Force criteria. Two investigators independently rated study quality, and interrater agreement was calculated. DATA SYNTHESIS: Sixty-four studies met inclusion criteria. Most studies used single-group cross-sectional (19 studies [29.7%]) or pre-post (41 studies [64.1%]) designs, and 4 (6.3%) were randomized, controlled trials. Five studies (7.8%) were multi-institutional. Twenty-four of 33 (72.7%) studies examining shift length reported that shorter shifts were associated with decreased medical errors, motor vehicle crashes, and percutaneous injuries. Only 2 studies assessed protected sleep time and reported that residents' adherence to naps was poor. Night floats described in 33 studies involved 5 to 7 consecutive nights. LIMITATIONS: Most studies used single-institution, observational designs. Publication bias is likely but difficult to assess in this methodologically weak and heterogeneous body of evidence. CONCLUSION: For the limited outcomes measured, most studies supported reducing shift length but did not adequately address the optimal shift duration. Studies had numerous methodological limitations and unclear generalizability for most outcomes. Specific recommendations about shift length, protected sleep time, and night float should acknowledge the limitations of this evidence. PRIMARY FUNDING SOURCE: Accreditation Council for Graduate Medical Education.

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Crossref · 10.7326/0003-4819-153-12-201012210-00010

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Research works printed but not linked: 3

  1. Richardson GS, 1996, Sleep, 19, 718
  2. Carey JC, 1989, Obstet Gynecol, 74, 668
  3. Lieu TA, 1992, Am J Dis Child, 146, 307

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Metadata

Authors
Reed, D. A., Fletcher, K. E., & Arora, V. M.
Affiliations
Mayo Clinic (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2010-12-21
Volume
153
Issue
12
Pages
829-842
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/0003-4819-153-12-201012210-00010
OpenAlex
W2067194865
Semantic Scholar
ada5611a3012a1833a810d645d097b1c4679fc61
Cited by
149
References
94
Citations by year
2026: 1 · 2025: 5 · 2024: 7 · 2023: 8 · 2022: 5 · 2021: 2 · 2020: 6 · 2019: 8 · 2018: 11 · 2017: 8 · 2016: 10 · 2015: 20 · 2014: 11 · 2013: 18 · 2012: 14
FWCI
2.63
Type
journal article
Language
en
Open access
closed
Licence
www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Leadership and Management › 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
shift length, night float, graduate medical education, interns, medical errors, residents' health, resident education, patient outcomes, napping, Accreditation Council for Graduate Medical Education
MeSH terms
Educational Measurement, Patient Care, Health Status, Humans, Internship and Residency, Personnel Staffing and Scheduling, Sleep, Time Factors, Work Schedule Tolerance

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