3052 — A Randomized Controlled Trial of the Feasibility of a Protected Sleep Period for Medical Interns in the Hospital for Prolonged Duty
Volpp KG, and Shea JA, VA Center for Health Equity Research and Promotion (CHERP), Philadelphia VA Medical Center; Small DS, Basner M, Zhu j, Norton L, Ecker A, Novak C, Bellini LN, and Dinges DF, University of Pennsylvania
The Accreditation Council for Graduate Medical Education (ACGME) released new duty hour standards based on recommendations from the Institute of Medicine Report that mandatory naps during overnight shifts could improve safety and reduce medical errors. Previous research indicated that naps have low adherence rates and do not succeed in significantly increasing amount slept while on call.
Medical interns at the Philadelphia VA Medical Center (PVAMC) and the Hospital of the University of Pennsylvania (HUP) were randomly assigned to either receive a standard intern schedule, with extended duty overnight shifts of up to 30 hours, or ‘mandatory naps,’ in which interns gave their cell phones to a resident from 00:30-05:30. Study participants wore wrist actiwatches, completed sleep diaries, and performed Psychomotor Vigilance Tests (PVT).
Interns on mandatory nap rotations had significantly longer mean sleep durations during protected periods (PVAMC: 2.6 vs. 1.6 hours, p-value <0.0001; HUP: 2.8 vs. 1.9 hours, p-value <0.0001). Nap participants were also significantly less likely to have call nights with no sleep (PVAMC: 12.5% vs. 26.9%, p-value <0.0001; HUP: 11.1% vs. 17.1%, p-value 0.04). PVT response speed was significantly faster in the intervention group after on-call nights (PVAMC: 3.84 vs. 4.07 per s, p-value 0.021; HUP: 3.89 vs. 4.04 per s, p-value 0.016), and the number of lapses was lower, albeit not significantly at HUP (PVAMC: 3.88 vs. 5.72, p-value 0.031; HUP: 3.95 vs. 4.73, p-value 0.059).
A mandatory nap intervention had high rate of adherence and significantly increased mean amount slept during and alertness following on-call nights.
This study provides evidence that protected sleep periods during prolonged duty are feasible and likely to increase the amount of time interns sleep on overnight shifts and improve behavioral alertness following on-call nights. In context of duty hour reforms that have affected all residency programs and teaching hospitals in the U.S, this could provide an alternative to more restrictive forms of regulation that limit hours worked to levels that teaching hospitals feel are financially unsustainable. Results will be discussed with ACGME and AAMC leadership and used to inform public debates of these issues.