Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison.
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.


OBJECTIVE
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.
Cappuccio
F P
FP
Sleep, Health & Society Programme, Clinical Sciences Research Institute, Warwick Medical School, Coventry, CV2 2DX, UK. f.p.cappuccio@warwick.ac.uk
Bakewell
A
A
Taggart
F M
FM
Ward
G
G
Ji
C
C
Sullivan
J P
JP
Edmunds
M
M
Pounder
R
R
Landrigan
C P
CP
Lockley
S W
SW
Peile
E
E
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D010865:Pilot Projects; D011446:Prospective Studies; D020178:Sleep Disorders, Circadian Rhythm / Q000517:prevention & control*; D006113:United Kingdom; D014940:Work Schedule Tolerance