Secondary Logo

Journal Logo


Extended shift worked in the hospital: we need protection from ourselves

Freund, Yonathan

Author Information
European Journal of Emergency Medicine: December 2019 - Volume 26 - Issue 6 - p 389
doi: 10.1097/MEJ.0000000000000635
  • Free

This year, a specialist doctor working in an urgent treatment center has been suspended from the UK medical register [1]. He was found to have worked 24 h in a row on several occasions, by doing back-to-back 12-h shifts at different centers.

Beyond the accusation of dishonestly failing to complete his shift by leaving before its end, the problem of his putting his patients at risk of medical error is real. We know that the risk of medical error in the emergency department is roughly of 10%, and that only systemic solutions may limit this risk [2,3]. Work hour regulation is one of them [4].

In the following perspective articles, we will glimpse different mentalities and regulations for extended shifts in different countries. There is a significant body of literature that highlights the risk of extended shifts both for the patient and for the emergency physician. Several different reasons may push a physician to work extended shifts, whether it is for money or personal convenience. In this journal, we previously reported that the level of burnout and mental stress is very high among emergency physicians, especially the youngest ones [5,6].

C.A. Graham wondered what will emergency care look like in 2027 [7]. I wonder what will emergency physicians look like then. I strongly hope that the specificity of our job will be sufficiently taken in to account so that emergency physicians will neither be willing nor permitted to work 24 h in a row [8]. When we are taking care of human lives, how can we justify explicitly dangerous and foolhardy behaviour?

Therefore, it is our feeling that administrative bodies, stakeholders and scientific societies must join us in calling for a clear ban on extended shifts from our clinical practice in Europe.


Conflicts of interest

There are no conflicts of interest.


1. Dyer C. Doctor who worked consecutive 12 hour shifts without telling employers is suspended for four months. BMJ. 2019; 366:l4619
2. Freund Y, Goulet H, Leblanc J, Bokobza J, Ray P, Maignan M, et al. Effect of systematic physician cross-checking on reducing adverse events in the emergency department: the CHARMED cluster randomized trial. JAMA Intern Med. 2018; 178:812–819
3. Camargo CA Jr, Tsai CL, Sullivan AF, Cleary PD, Gordon JA, Guadagnoli E, et al. Safety climate and medical errors in 62 US emergency departments. Ann Emerg Med. 2012; 60:555–563.e20
4. Landrigan CP, Rothschild JM, Cronin JW, Kaushal R, Burdick E, Katz JT, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004; 351:1838–1848
5. Mache S, Bernburg M, Baresi L, Groneberg D. Mental health promotion for junior physicians working in emergency medicine: evaluation of a pilot study. Eur J Emerg Med. 2018; 25:191–198
6. Truchot J, Chauvin A, Hutin A, Leredu T, Plaisance P, Yordanov Y. Burnout and satisfaction among young emergency physicians. Eur J Emerg Med. 2018; 25:445–446
7. Graham CA. What will emergency care look like 10 years from now? Eur J Emerg Med. 2017; 24:391
8. Graham CA. Emergency care systems: increasing pressures but little sustainability. Eur J Emerg Med. 2017; 24:157
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.