Doctor Scheduling: Sleeping on the Job

The Scheduler’s Axiom of “never publish an on-call schedule you would not do yourself”, is even more relevant after recent episodes of Control Tower Operators being disciplined for napping on the job. How does the way you schedule on-call affect next-day physician performance and patient outcomes? How much recovery time is needed after night on-call duty, and is it different depending on Specialty?

The requirements for on-call have changed over the past few decades with a tendency for more intense night on-call work, sometimes resembling a full night shift even if the actual shift length is shortened. While there seems to be limited knowledge about the effects of night on-call duty on sleep and recovery time, especially given the irregular character of on-call schedules and the variable durations of the “shift”, a recent Swedish study may start to change that.

The Swedish study examined “Sleep and recovery in physicians on night call”^[1], comparing the recovery time of a group of 15 anesthesiologists with a group made up of 17 pediatricians and ENT surgeons. Interestingly, both groups needed the same average recovery time from on-call: two night’s sleep (17 percent reported needing one night’s sleep, 73 percent reported needed two nights’ sleep, and 10 percent, reported needing three nights’ sleep or more).

So, what does this mean to you as a Scheduler?

Some would suggest the idea of “sleep regulations”, including avoiding scheduling elective procedures for Providers the day after they have been on night call unless they first obtain the patient’s informed consent regarding the risks^[2]. Others would encourage a two-day minimum spacing between on-call and surgical duty when creating the on-call schedules to minimize such conflicts.

The next time there is a Physician meeting regarding scheduling, it would be worthwhile documenting Rules that are adhered to as a group, vs Preferences that are “nice to have”.

Night on-call spacing is too vital to be left to chance.

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Resources:

[1]. From: http://www.biomedcentral.com/1472-6963/10/239. Sleep and recovery in physicians on night call, a longitudinal field study

“The fact that the physicians did not report any problems with insomnia or sleepiness speaks against the present working schedules causing any severe adverse effects on sleep in general. However, the previous polysomnographic study of physicians on call showed a preserved amount of deep sleep during the call, but a large loss of REM (rapid eye movement) sleep. This is also a well-known pattern from experimental studies of shift work. Even though the SWS was probably sufficiently recovered, some adverse effects of insufficient REM sleep in the present participants cannot be ruled out. Nevertheless, the unexpected finding of short sleep after their ordinary workdays is more troubling. Hence, even though sleep quality and sleep efficiency were sufficient in the whole group of physicians, they may still have a general sleep deficiency, which may constitute a health risk in a long-term perspective.”

[2]. http://www.theheart.org/article/1171059.do. Physician groups bristle at proposed “sleep regulations”

Tags: Doctor Scheduling, On-Call, call schedule management, physician scheduling