QJM Advance Access published online on January 27, 2009
QJM, doi:10.1093/qjmed/hcp004
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Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients’ safety: assessor-blind pilot comparison
From the 1Sleep, Health & Society Programme, Clinical Sciences Research Institute, Warwick Medical School, Coventry, CV2 2DX, UK, 2Harvard Work Hours Health & Safety Group, Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital and Children's Hospital, Boston, MA, USA, 3University Hospitals Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX and 4Royal College of Physicians, London, NW1 4LE, UK
Address correspondence to Prof. Francesco P Cappuccio, M.D. F.R.C.P. F.F.P.H. F.A.H.A., Cardiovascular Medicine & Epidemiology Research Group, Clinical Sciences Research Institute, University of Warwick Medical School, Coventry CV2 2DX, UK, email: f.p.cappuccio{at}warwick.ac.uk
Received 18 August 2008 and in revised form 29 December 2008
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Abstract |
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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.
*These authors contributed equally to this work.
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