ICU administration · Doctors' working patterns
Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts
| Design | Multicentre cluster-randomised crossover trial |
|---|---|
| Treatment | Resident schedule eliminating extended 24-hour shifts |
| Control | Traditional schedule including 24-hour shifts |
| Population | Resident physicians and their ICU patients across six centres |
| Follow-up | Duration of each rotation |
| Primary endpoint | Rate of serious medical errors made by resident physicians |
| Result | Resident workload was higher on the intervention schedule (8.8±2.8 versus 6.7±2.2 ICU patients per resident). Residents made more serious errors on the intervention schedule — 97.1 versus 79.0 per 1000 patient-days (relative risk 1.53, 95% CI 1.37 to 1.72, p<0.001) — and unit-wide serious errors were likewise higher, 181.3 versus 131.5 per 1000 patient-days (relative risk 1.56, 1.43 to 1.71). There was wide variation between sites. |
| Secondary endpoints | Preventable adverse events, resident sleep, handover frequency |
Contrary to our hypothesis, resident physicians who were randomly assigned to schedules that eliminated extended shifts made more serious errors than resident physicians assigned to schedules with extended shifts.
The trial authors, in the published abstract
A genuinely surprising result, and the authors say so. The likely mechanism is handover: fewer hours per doctor means more transfers of care, and each transfer is a chance to lose information. Fatigue is a real hazard, but so is discontinuity.
Landrigan CP, Rahman SA, Sullivan JP, et al. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts. N Engl J Med 2020 Jun 25;382(26):2514-2523.