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Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing

Bakhru, Rita N., MD, MSCE1,2; Basner, Mathias, MD, PhD, MSc3; Kerlin, Meeta Prasad, MD, MSCE4; Halpern, Scott D., MD, PhD4; Hansen-Flaschen, John, MD4; Rosen, Ilene M., MD, MSCE4,5; Dinges, David F., MS, MA, PhD3; Schweickert, William D., MD4

doi: 10.1097/CCM.0000000000003773
Feature Article: PDF Only

Objectives: To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model.

Design: Prospective observational study.

Setting: Medical ICU of a tertiary care academic medical center during a randomized controlled trial of in-hospital nighttime intensivist staffing.

Patients: Twenty faculty and 13 fellows assigned to rotations in the medical ICU during 2012.

Interventions: As part of the parent study, there was weekly randomization of staffing model, stratified by 2-week faculty rotation. During the standard staffing model, there were in-hospital residents, with a fellow and faculty member available at nighttime by phone. In the intervention, there were in-hospital residents with an in-hospital nighttime intensivist. Fellows and faculty completed diaries detailing their sleep, work, and well-being; wore actigraphs; and performed psychomotor vigilance testing daily.

Measurements and Main Results: Daily sleep time (mean hours [SD]) was increased for fellows and faculty in the intervention versus control (6.7 [0.3] vs 6.0 [0.2]; p < 0.001 and 6.7 [0.1] vs 6.4 [0.2]; p < 0.001, respectively). In-hospital work duration did not differ between the models for fellows or faculty. Total hours of work done at home was different for both fellows and faculty (0.1 [< 0.1] intervention vs 1.0 [0.1] control; p < 0.001 and 0.2 [< 0.1] intervention vs 0.6 [0.1] control; p < 0.001, respectively). Psychomotor vigilance testing did not demonstrate any differences. Measures of well-being including physical exhaustion and alertness were improved in faculty and fellows in the intervention staffing model.

Conclusions: Although no differences were measured in patient outcomes between the two staffing models, in-hospital nighttime intensivist staffing was associated with small increases in total sleep duration for faculty and fellows, reductions in total work hours for fellows only, and improvements in subjective well-being for both groups. Staffing models should consider how work duration, sleep, and well-being may impact burnout and sustainability.

1Section of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC.

2Critical Illness, Injury and Recovery Center, Wake Forest School of Medicine, Winston-Salem, NC.

3Division of Sleep and Chronobiology, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.

4Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

5Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Drs. Bakhru, Basner, Rosen, Dinges, and Schweickert were involved in the conceptualization and design of the study. Drs. Bakhru, Basner, and Schweickert performed analysis of the data and the initial interpretation of the data. Drs. Bakhru and Schweickert drafted the initial article. Review and approval of the article were completed by all of the authors.

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Dr. Bakhru’s effort was supported by National Institutes of Health (NIH) T32-HL007891 and the Wake Forest University Claude D. Pepper Older Americans Independence Center (P30-AG21332). Drs. Bakhru, Halpern, and Dinges received support for article research from the NIH. Dr. Rosen received funding from Board of Directors of the American Academy of Sleep Medicine (stipend and travel expenses); Accreditation Council of Graduate Medical Education (sleep medicine representative to the Residency Review Committee for Internal Medicine (travel expenses); UpToDate (co-authored a card on oxygen delivery and receive royalties); she disclosed that she has a grant from the NIH to develop online learning sleep medicine learning modules for primary care physicians and an unrestricted educational grant from Jazz Pharmaceuticals to support fellowship training in sleep medicine; and she disclosed that she had unrestricted educational grants from ResMed, Merck, and Jazz Pharmaceuticals during the time the study was conducted. Dr. Schweickert received funding from Hill Rom, Arjo, Society of Critical Care Medicine, and American College of Physicians (consulting). The remaining authors have disclosed that they do not have any potential conflicts of interest.

This work was performed at the University of Pennsylvania, Philadelphia, PA.

Clinical Trial Registration: This trial is registered at NCT01434823.

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