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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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Burnout Among U.S. Medical Students, Residents, and Early Career Physicians Relative to the General U.S. Population
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See all 149

Authors: Reed, D. A., Fletcher, K. E., & Arora, V. M.
Affiliations: Mayo Clinic (US)
ORCID: Reed, Darcy A.
Fletcher, Kathlyn E.
Arora, Vineet M.
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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Systematic Review: Association of Shift Length, Protected Sleep Time, and Night Float With Patient Care, Residents' Health, and Education

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