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
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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“Furthermore, longer work hours in medical residents have been associated with markers of reduced work performance, although impacts on actual work performance are more inconsistent.115,222”
From Sleep, Health, and Society (2017) · cites this paper as [222]
In the citing paper
“Furthermore, longer work hours in medical residents have been associated with markers of reduced work performance, although impacts on actual work performance are more inconsistent.115,222”
From Sleep, Health, and Society (2017) · cites this paper as [222]
In the citing paper
“These restrictions, although controversial,115,251–253 are likely resulting in increased sleep among medical residents.222”
From Sleep, Health, and Society (2017) · cites this paper as [222]
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Metadata
- Authors
- Reed, D. A., Fletcher, K. E., & Arora, V. M.
- Affiliations
- Mayo Clinic (US)
- 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
- 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
- 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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