Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison
Cappuccio, Francesco P., Bakewell, A., Taggart, Frances M, Ward, G., Ji, Chen, Sullivan, J.P., Edmunds, M., Pounder, R., Landrigan, C.P., Lockley, S.W. and Peile, Ed. (2009) Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety : assessor-blind pilot comparison. QJM, Vol.102 (No.4). pp. 271-282. ISSN 1460-2725
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Official URL: http://dx.doi.org/10.1093/qjmed/hcp004
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.
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.
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.
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.
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.
|Item Type:||Journal Article|
|Subjects:||R Medicine > R Medicine (General)|
|Divisions:||Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing
Faculty of Medicine > Warwick Medical School > Translational & Systems Medicine > Metabolic and Vascular Health
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Physicians -- Great Britain, Physicians -- Health and hygiene, Hours of labor -- Law and legislation -- Europe|
|Journal or Publication Title:||QJM|
|Publisher:||Oxford University Press|
|Official Date:||27 January 2009|
|Page Range:||pp. 271-282|
|Access rights to Published version:||Open Access|
|Funder:||Great Britain. National Health Service (NHS)|
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).
36. Santhi N, Horowitz TS, Duffy JF, Czeisler CA. Acute sleep deprivation and circadian misalignment associated with transition onto the first night of work impairs visual selective attention. PLoS One (2007) 2:e1233.ctor. Br Med J (2008) 336:218.
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