I read a fascinating study1 this morning (thank you to @docmom61.bsky.social for the link!) For those in medicine, you know why this paper on call schedules and sleep deprivation is important … because you’ve lived it.
For those who are not in medicine, it’s important to understand how schedules in medicine are created, and why (but the why is a more philosophical discussion for another time, one that is about margins, missions, and meaning).
This study prospectively compared two groups of residents working in pediatric ICUs who were assigned to two different call schedules. The cool science here is that they modeled different schedules to choose which one to test against “the way we’ve always done it”.
The first group (EDWR) was, in effect, the control group, since they were put into a traditional Extended Duration Work Roster (24-28 hrs of continuous call with up to 88 hours/wk of total call). The other group (RCWR) was assigned to a Rapidly Changing Work Roster with variable lengths of call designed to limit extended call hours . (“…scheduled continuous duty hours limited to 16 hours (RCR-16) consisting of a short day shift (7:00-15:00), a long day shift (7:00-22:00), and a long night shift (21:00-13:00).”)
The RCWR is not a schedule I’ve seen before, but it does make sense. More importantly, it’s based on mathematical models, not fingers on our hands or days in a week!* For anyone who has seen the unintended consequences (emotional as well as physical) of the isolating night float system, anything new to consider is a welcomed alternative.
Here are my takeaways…
- Total amount of sleep in the week (regardless of the schedule) was associated with less impairment. Focusing on more sleep is always the right answer if you are a physician, physician-in-training, or other healer.
- It was a little easier to get more sleep on the RCWR schedule. The big picture here is that we need to be able to think out of the box when it comes to call schedules. Just because it has “always been this way” doesn’t mean it’s the right thing to do.
- There was a lot of variability (for many reasons, all discussed in the paper) This is hard science to do, but important.
*Lest we think we choose numbers in medicine scientifically… have you ever noticed that we usually prescribe antibiotics based on American football scores? (Think about it… just where did our standard 7, 10, 14, or 21 days come from?)