Introduction of night shift call system for surgical trainees: a prospective self-controlled trial.
OBJECTIVE
The number of hours worked by specialty trainees has come under scrutiny recently. One approach aimed at decreasing the number of consecutive hours worked is the night shift call system (NSCS). This study aimed to determine the advantages and disadvantages of an NSCS compared with those of the conventional overnight call system (ONCS).


METHODS
Sixteen basic surgical trainees (BSTs) from our unit participated in this prospective, self-controlled trial. During April 2000, the conventional 1-in-4 ONCS with a post-call half-day off was instituted. From May to June 2000, each BST rotated to work 1 week of night duty (20.00-08.00) and 7 weeks of daytime duty. A battery of neuropsychological tests were administered to the group after call during the study period.


RESULTS
On average the numbers of consecutive hours worked during the NSCS and ONCS periods were 12 and 28 hours, respectively. There was no difference in numbers of errors committed and no difference in discrepancy between diagnoses made on admission and discharge. Two of the simple neuropsychological tests (memory scanning and addition tests) showed a significant fall-off in performance during the ONCS period (P < 0.05). Most specialists preferred the ONCS, while the majority of the BSTs preferred the NSCS (P < 0.05). This was because without extra manpower, the overall workloads of senior staff were increased.


CONCLUSIONS
The NSCS is 1 way of reducing work hours, and was associated with significantly less impaired cognition on the part of our BSTs. It is only feasible if extra relieving staff are available to cover daytime duties.
Lee
Daniel Tai Yam
DT
Department of Surgery, United Christian Hospital, Kwun Tong, Kowloon, Hong Kong. danieltylee@hotmail.com
Chan
Sharon Wing Wai
SW
Kwok
Samuel Po Yin
SP
D039602:After-Hours Care; D013502:General Surgery / Q000193:education*; D006723:Hong Kong; D006801:Humans; D019300:Medical Errors; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000592:standards / Q000600:supply & distribution; D009483:Neuropsychological Tests; D009551:Night Care / Q000523:psychology; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D011787:Quality of Health Care; D014940:Work Schedule Tolerance / Q000523:psychology*; D000078329:Workforce; D016526:Workload / Q000592:standards