Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Small naps a big help for young docs on long shifts

06.06.2006


The first study to assess the benefits of naps for medical residents during extended shifts found that creating protected times when interns could sleep during a night on-call significantly reduced fatigue.



In the June 6, 2006, issue of the Annals of Internal Medicine, researchers from the University of Chicago report that although average sleep time for interns in the study increased only modestly -- by about one hour -- the interns felt that even small gains in sleep led to substantial improvements in fatigue, sleep quality and ability to care for their patients.

"This is a proven method of alleviating fatigue in industries that combine high intensity with long shifts," said study director Vineet Arora, M.D., instructor of medicine at the University of Chicago, "yet is has been neglected by the one industry that studies sleep. Our results show that a well timed nap can provide a significant boost in physician concentration and take away some of the burden of chronic sleep deprivation."


The researchers studied 38 first-year medical residents (also known as interns) on the general medicine service at the University of Chicago Hospital from July 2003 to June 2004. For several month-long periods during that year, the interns were on-call every fourth night. Interns on-call often work a 30-hour shift, consisting of a full day, then a night on-call, followed by a shorter day. Each intern wore an "Actiwatch" for the entire month, which recorded his or her movements around the hospital, time in bed and time asleep.

For two weeks out of each month on-call, interns followed the standard schedule, grabbing a little sleep whenever they could during the night shift. For the other two weeks they had access to protected time, allowing them to nap. Those on the nap schedule were "strongly encouraged" to forward the care of their patients to a designated "night-float" resident who would cover for them between midnight and 7 a.m.

During 119 total months on service, the 38 interns were randomly prompted during on-call and post-call days (but not between midnight and 7 a.m.) to report their fatigue at that moment, using the seven-point Stanford Sleepiness Scale. One point indicates "feeling active and vital, alert, wide awake," and seven points indicates "almost in reverie, sleep onset soon, losing struggle to remain awake."

Interns on the nap schedule increased their average sleep time by 41 minutes, from 144 minutes a night up to 185 minutes. Interns on the nap schedule who forwarded their pagers to the "night-float" resident increased their sleep times even more, from 142 up to 210 minutes. Sleep efficiency – the ration between time in bed and time asleep – also improved for those on the nap schedule, from 73 percent, considered abnormal, up to 80 percent.

When prompted, interns on the nap schedule reported far less fatigue. They logged an overall sleepiness rating of 1.74 compared to 2.26 for those on the standard schedule. (Lower is better.) They had lower scores while on call, 1.59 versus 2.06, and much lower scores the day after being on call, 2.23 versus 3.16.

"A rating of one or even two is consistent with peak performance," said Arora, but people may start to get "sluggish," she said, at three. Anything above three is "clinically relevant."

The researchers found, however, that despite mounting fatigue and the allure of protected sleep time, interns were reluctant to rely on the night-float residents, forwarding their pagers only 22 percent of available opportunities. When interviewed, interns emphasized the importance of caring for their own patients and concerns about losing important information whenever responsibility is transferred back and forth with another physician.

"Our study," the authors wrote, "suggests that these young physicians are choosing to care for their patients over their own immediate welfare."

Although interns did not mind sacrificing sleep for their own patients, they did not feel the same allegiance when they had to "cross-cover" patients whom they did not know to help other physicians. Many found ways to retain the pages for their own patients but were happy to transfer others to the night-float resident.

At a time, the authors note, when newly imposed restrictions on resident hours result in more frequent cross-coverage, "this finding is concerning."

As hospitals nationwide search for ways to reduce resident sleep deprivation, many have considered shorter shifts. This study suggests that an extended long shift, punctuated by a substantial nap, may be more effective, reducing levels of resident fatigue but also limiting the amount of time that patients would be cared for by covering physicians, "a known risk factor for preventable adverse effects."

In response to this study, all interns on the general medicine service at the University of Chicago Hospitals now have access to night-float coverage and are encouraged to take advantage of the opportunity to sleep.

John Easton | EurekAlert!
Further information:
http://www.uchospitals.edu

More articles from Studies and Analyses:

nachricht Obstructing the ‘inner eye’
07.07.2017 | Friedrich-Schiller-Universität Jena

nachricht Drone vs. truck deliveries: Which create less carbon pollution?
31.05.2017 | University of Washington

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Manipulating Electron Spins Without Loss of Information

Physicists have developed a new technique that uses electrical voltages to control the electron spin on a chip. The newly-developed method provides protection from spin decay, meaning that the contained information can be maintained and transmitted over comparatively large distances, as has been demonstrated by a team from the University of Basel’s Department of Physics and the Swiss Nanoscience Institute. The results have been published in Physical Review X.

For several years, researchers have been trying to use the spin of an electron to store and transmit information. The spin of each electron is always coupled...

Im Focus: The proton precisely weighted

What is the mass of a proton? Scientists from Germany and Japan successfully did an important step towards the most exact knowledge of this fundamental constant. By means of precision measurements on a single proton, they could improve the precision by a factor of three and also correct the existing value.

To determine the mass of a single proton still more accurate – a group of physicists led by Klaus Blaum and Sven Sturm of the Max Planck Institute for Nuclear...

Im Focus: On the way to a biological alternative

A bacterial enzyme enables reactions that open up alternatives to key industrial chemical processes

The research team of Prof. Dr. Oliver Einsle at the University of Freiburg's Institute of Biochemistry has long been exploring the functioning of nitrogenase....

Im Focus: The 1 trillion tonne iceberg

Larsen C Ice Shelf rift finally breaks through

A one trillion tonne iceberg - one of the biggest ever recorded -- has calved away from the Larsen C Ice Shelf in Antarctica, after a rift in the ice,...

Im Focus: Laser-cooled ions contribute to better understanding of friction

Physics supports biology: Researchers from PTB have developed a model system to investigate friction phenomena with atomic precision

Friction: what you want from car brakes, otherwise rather a nuisance. In any case, it is useful to know as precisely as possible how friction phenomena arise –...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Closing the Sustainability Circle: Protection of Food with Biobased Materials

21.07.2017 | Event News

»We are bringing Additive Manufacturing to SMEs«

19.07.2017 | Event News

The technology with a feel for feelings

12.07.2017 | Event News

 
Latest News

NASA looks to solar eclipse to help understand Earth's energy system

21.07.2017 | Earth Sciences

Stanford researchers develop a new type of soft, growing robot

21.07.2017 | Power and Electrical Engineering

Vortex photons from electrons in circular motion

21.07.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>