title: Effects of shift length on quality of patient care and health provider outcomes: systematic review.
abstract: BACKGROUND
  Healthcare providers work increasingly under a variety of shift work systems to cover the continuous care required by patients. However, the effects of shift work on patient and provider outcomes in healthcare settings has not been systematically evaluated.
  
  
  OBJECTIVE
  To identify and analyse the available evidence on the effect of shift length (8-h vs 12-h shifts) on quality of patient care and healthcare provider outcomes.
  
  
  METHODS
  Systematic searching of eight online databases, key governmental/organisational websites and academic journals with ancestry search of relevant articles (limited to articles published in English and Spanish).
  
  
  RESULTS
  Of 562 articles that were retrieved from 20 446 titles identified through database and manual searches, 27 satisfied the inclusion criteria, of which 15 were rejected because of low methodological quality. The 12 final studies included cross-sectional/survey (7), before-after (3) and prospective cohort (2) designs. The main primary outcomes evaluated were: (1) quality of patient care and (2) healthcare provider outcomes. The results were equivocal. With respect to the effect of shift length on quality of patient care, two studies found that errors and near errors were associated with working longer shifts, and another study reported decreased patient complications and length of stay with longer shifts. Specific healthcare provider outcomes such as health complaints, well-being, drug and alcohol consumption, stress and job satisfaction were mostly evaluated by single studies and therefore there was insufficient evidence from which to draw conclusions.
  
  
  CONCLUSIONS
  Methodological quality of the studies generally was low and results equivocal with insufficient evidence to determine the effects of shift length on quality of patient care and healthcare provider outcomes. Clearly, robust well-designed studies are needed to examine the effect of shift length on patient and healthcare provider outcomes.
authors.affiliation: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. carole.estabrooks@ualberta.ca
authors.forename: C A
authors.initials: CA
authors.lastname: Estabrooks
authors.forename: G G
authors.initials: GG
authors.lastname: Cummings
authors.forename: S A
authors.initials: SA
authors.lastname: Olivo
authors.forename: J E
authors.initials: JE
authors.lastname: Squires
authors.forename: C
authors.initials: C
authors.lastname: Giblin
authors.forename: N
authors.initials: N
authors.lastname: Simpson
mesh_terms: D006282:Health Personnel; D006801:Humans; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling; D011787:Quality of Health Care; D016526:Workload