Sleep and Shifts

Dominic Slade, (ASiT)

Powerpoint File

The Problem

The European Working Time Directive (EWTD, 93/104/EC) introduced in the UK in 1998, has applied to doctors in training since August 2004. Virtually all surgical trainees now work shift patterns which include a week of continuous night duties. Implementation of shifts has been at trust level, poorly researched, implemented by departments who may lack proper human resource training and are considered by trainees to be the least productive use of their precious training time. Coupled with this, trusts have removed "on-call" rooms and threatened disciplinary action against doctors caught sleeping during their shift. Some trusts have suggested that surgical SpRs at a loose end should "pop down" to the Emergency Department and help out with clerking medical patients.

Impact of shifts on Health

Research into night shift working shows it has a significant negative impact on workers' health.

In the short term, night shifts cause sleep disturbance, fatigue, shift-lag syndrome, psychosomatic illnesses, and most worryingly an increased tendency towards accidents.

In the long term, shift workers;

Are 2-5 times more likely to suffer peptic ulcers and gastrointestinal disease at a younger age1

Are 40% more likely to suffer cardiovascular disease1

Are more likely to have a social drug addiction to caffeine, cigarettes or alcohol2

Have a decreased life expectancy

Doctors are not typical night workers, covering just one week of nights in a typical 7-8 week rota. This kind of working has been less well investigated but studies of police officers suggests that it takes five to seven consecutive shifts to develop suitable alertness at night (Circadian phase shift) and a similar period to readjust to daytime working3. The impact of this on medical errors and training is unknown.

Conclusion

Current shift patterns have been conceived purely as a mathematical product of the number of doctors available to cover the number of on-call hours with scant regard to their impact on training. There are considerable Health and Safety issues surrounding these shifts as well as the detrimental effects they may be having on training.

1 K Sakate et al 2003 J Occup Envir Med

2 Joi 2001 Ergology

3 "Healthy Nights" Home Office