Wednesday, July 12, 2006

Napping doctors

An article (subscriber only) in this week's Science News looked at the effects of allowing medical interns to nap while on the job. Interns at the hospital where the study was carried out were typically on call for a continuous 30-hour shift, but Arora et al. (2006) allowed some interns to officially pass off their ball and chain pager to another doctor for a part of their shift. This allowed the interns to rest uninterrupted, an apparently rare occurrence for a doctor fresh out of medical school. Here are Arora et al.'s results (from the abstract, as I don't have access to the full article):
Interns received 41 more minutes of sleep while on call with the nap schedule (185 minutes vs. 144 minutes; P < 0.001). When interns with the nap schedule used coverage, they received 68 more minutes of sleep (210 minutes vs. 142 minutes; P < 0.001). Despite these small increases in sleep, interns reported less overall fatigue while on the nap schedule than while on the standard schedule (1.74 vs. 2.26; P = 0.017).
Being treated by a doctor who is feeling less fatigued1 is, I think it is safe to say, a good thing. A similar result was found in a paper published a few years ago (Lockley et al. 2004) that looked at reducing the work hours of first-year residents in an intensive care unit. That study limited interns to working no more than 16-hour shifts (have I mentioned how crazy it is to apply the word "limited" to the phrase "16-hour shifts" in any context outside of firefighters and soldiers?), and found the following:
Seventeen of 20 interns worked more than 80 hours per week during the traditional schedule (mean, 84.9; range, 74.2 to 92.1). All interns worked less than 80 hours per week during the intervention schedule (mean, 65.4; range, 57.6 to 76.3). On average, interns worked 19.5 hours per week less (P<0.001), slept 5.8 hours per week more (P<0.001), slept more in the 24 hours preceding each working hour (P<0.001), and had less than half the rate of attentional failures while working during on-call nights (P=0.02) on the intervention schedule as compared with the traditional schedule.
I'd once again have to argue that having "half the rate of attentional failures" is almost certainly a good thing. What baffles me, however, is the ending sentence of the Science News article:
Arora's team suggests that interns with increased nap time may be capable of staying on call for more than 30 consecutive hours, the current nationwide limit.
I don't have the full journal article, so I don't know what context this suggestion was used in, but I sure hope that Arora et al. aren't arguing that interns should be worked for more than 30 hours straight at a time.

Next time you got to the hospital, be sure to ask your friendly neighborhood intern if they've had ther nap recently.

Notes and references:

1 Fatigue in Arora et al.'s (2006) study was quantified using the "7-point Stanford Sleepiness Scale", wherein 7 is the sleepiest and 1 is the most awake.

Arora, V., C. Dunphy, V. Y. Chang, F. Ahmad, H. J. Humphrey and D. Meltzer. 2006. The Effects of On-Duty Napping on Intern Sleep Time and Fatigue. Annals of Intern Medicine 144: 792-798. (abstract)

Lockley, Steven W., Cronin, John W., Evans, Erin E., Cade, Brian E., Lee, Clark J., Landrigan, Christopher P., Rothschild, Jeffrey M., Katz, Joel T., Lilly, Craig M., Stone, Peter H., Aeschbach, Daniel, Czeisler, Charles A., the Harvard Work Hours, Health and Safety Group. 2004. Effect of Reducing Interns' Weekly Work Hours on Sleep and Attentional Failures. New England Journal of Medicine 351: 1829-1837. (abstract)


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