Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison

Article English OPEN
Cappuccio, Francesco ; Bakewell, A. ; Taggart, Frances M. ; Ward, G. ; Ji, Chen ; Sullivan, J.P. ; Edmunds, M. ; Pounder, R. ; Landrigan, C. P. ; Lockley, S. W. ; Peile, Ed (2009)
  • Publisher: Oxford University Press
  • Journal: QJM: An International Journal of Medicine (issn: 1460-2725, vol: 102, pp: 271-282)
  • Related identifiers: doi: 10.1093/qjmed/hcp004, pmc: PMC2659599
  • Subject: Original Papers | R1

Background: There are currently no field data about the effect of implementing European Working Time Directive (EWTD)-compliant rotas in a medical setting. Surveys of doctors’ subjective opinions on shift work have not provided reliable objective data with which to evaluate its efficacy. \ud \ud Aim: We therefore studied the effects on patient's safety and doctors’ work-sleep patterns of implementing an EWTD-compliant 48 h work week in a single-blind intervention study carried out over a 12-week period at the University Hospitals Coventry & Warwickshire NHS Trust. We hypothesized that medical error rates would be reduced following the new rota. \ud \ud Methods: Nineteen junior doctors, nine studied while working an intervention schedule of <48 h per week and 10 studied while working traditional weeks of <56 h scheduled hours in medical wards. Work hours and sleep duration were recorded daily. Rate of medical errors (per 1000 patient-days), identified using an established active surveillance methodology, were compared for the Intervention and Traditional wards. Two senior physicians blinded to rota independently rated all suspected errors. \ud \ud Results: Average scheduled work hours were significantly lower on the intervention schedule [43.2 (SD 7.7) (range 26.0–60.0) vs. 52.4 (11.2) (30.0–77.0) h/week; P < 0.001], and there was a non-significant trend for increased total sleep time per day [7.26 (0.36) vs. 6.75 (0.40) h; P = 0.095]. During a total of 4782 patient-days involving 481 admissions, 32.7% fewer total medical errors occurred during the intervention than during the traditional rota (27.6 vs. 41.0 per 1000 patient-days, P = 0.006), including 82.6% fewer intercepted potential adverse events (1.2 vs. 6.9 per 1000 patient-days, P = 0.002) and 31.4% fewer non-intercepted potential adverse events (16.6 vs. 24.2 per 1000 patient-days, P = 0.067). Doctors reported worse educational opportunities on the intervention rota. \ud \ud Conclusions: Whilst concerns remain regarding reduced educational opportunities, our study supports the hypothesis that a 48 h work week coupled with targeted efforts to improve sleep hygiene improves patient safety. \ud \ud \ud \ud
  • References (49)
    49 references, page 1 of 5

    1. Jaeger vs. Landeshauptstadt Kiel. Social Policy - Council Directive 93/1 04/EC - Concepts of working time and rest period - On-call service provided by doctors in hospitals 2003.

    2. NHS Management Executive, Hours of Work of Doctors in Training, NHS Management Executive, 1991.

    3. British Medical Association. http://www.bma.org.uk/ap.nsf/ Content/NIEWTD (accessed 8th April 2008).

    4. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, et al. Effect of reducing intern's work hours on serious medical errors in intensive care units. New Engl J Med 2004; 351:1838-48.

    5. Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, Speizer FE, Czeisler CA. Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. Plos Med 2006; 3:e487.

    6. Lockley SW, Cronin JW, Evans EE, Cade BE, Lee CJ, Landrigan CP, et al. Effect of reducing interns' weekly work hours on sleep and attentional failures. New Engl J Med 2004; 351:1829-37.

    7. Folkard S, Tucker P. Shift work, safety and productivity. Occup Med 2003; 53:95-101.

    8. Folkard S, Lombardi DA, Tucker PT. Shift work: safety, sleepiness and sleep. Industrial Health 2005; 43:20-3.

    9. Barger LK, Cade BE, Ayas NT, Cronin JW, Rosner B, Speizer FE, et al. Extended work shifts and the risk of motor vehicle crashes among interns. New Engl J Med 2005; 352:125-34.

    10. Ayas NT, Barger LK, Cade BE, Hashimoto DM, Rosner B, Cronin JW, et al. Extended work duration and the risk of selfreported percutaneous injuries in interns. JAMA 2006; 296:1055-62.

  • Related Research Results (1)
  • Metrics
    No metrics available
Share - Bookmark