系统评价：轮班时长、保障睡眠时间和夜间小夜班与患者护理、住院医师健康和教育的关联。

Systematic review: association of shift length, protected sleep time, and night float with patient care, residents' health, and education.

机构信息

Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

出版信息

Ann Intern Med. 2010 Dec 21;153(12):829-42. doi: 10.7326/0003-4819-153-12-201012210-00010.

DOI:10.7326/0003-4819-153-12-201012210-00010

PMID:21173417

Abstract

BACKGROUND

The Accreditation Council for Graduate Medical Education's new duty-hour standards limit interns' shifts to 16 hours and night float to 6 consecutive nights. Protected sleep time (that is, "nap") is strongly encouraged. As duty-hour reforms are implemented, examination of the quality and outcomes of the relevant literature is important.

PURPOSE

To systematically review the literature examining shift length, protected sleep time, and night float.

DATA SOURCES

MEDLINE, PREMEDLINE, and EMBASE from January 1989 through May 2010.

STUDY SELECTION

Studies examined the associations of shift length, protected sleep time, or night float with patient care, resident health, and education outcomes among residents in practice settings.

DATA EXTRACTION

Study quality was measured by using the validated Medical Education Research Study Quality Instrument and the U.S. Preventive Services Task Force criteria. Two investigators independently rated study quality, and interrater agreement was calculated.

DATA SYNTHESIS

Sixty-four studies met inclusion criteria. Most studies used single-group cross-sectional (19 studies [29.7%]) or pre-post (41 studies [64.1%]) designs, and 4 (6.3%) were randomized, controlled trials. Five studies (7.8%) were multi-institutional. Twenty-four of 33 (72.7%) studies examining shift length reported that shorter shifts were associated with decreased medical errors, motor vehicle crashes, and percutaneous injuries. Only 2 studies assessed protected sleep time and reported that residents' adherence to naps was poor. Night floats described in 33 studies involved 5 to 7 consecutive nights.

LIMITATIONS

Most studies used single-institution, observational designs. Publication bias is likely but difficult to assess in this methodologically weak and heterogeneous body of evidence.

CONCLUSION

For the limited outcomes measured, most studies supported reducing shift length but did not adequately address the optimal shift duration. Studies had numerous methodological limitations and unclear generalizability for most outcomes. Specific recommendations about shift length, protected sleep time, and night float should acknowledge the limitations of this evidence.

PRIMARY FUNDING SOURCE

Accreditation Council for Graduate Medical Education.

摘要

背景

研究生医学教育认证委员会的新工作时间标准将实习生的轮班时间限制为 16 小时，并将夜间轮班限制为连续 6 个晚上。强烈鼓励保护睡眠时间（即“小睡”）。随着工作时间改革的实施，检查相关文献的质量和结果非常重要。

目的

系统回顾检查轮班时间、保护睡眠时间和夜间轮班的文献。

资料来源

MEDLINE、PREMEDLINE 和 EMBASE 从 1989 年 1 月到 2010 年 5 月。

研究选择

研究检查了轮班时间、保护睡眠时间或夜间轮班与实践环境中居民的患者护理、居民健康和教育结果之间的关联。

数据提取

使用经过验证的医学教育研究质量工具和美国预防服务工作组标准来衡量研究质量。两名研究人员独立评估研究质量，并计算了相互评估者之间的一致性。

数据综合

64 项研究符合纳入标准。大多数研究使用单组横断面（19 项研究[29.7%]）或前后（41 项研究[64.1%]）设计，4 项（6.3%）为随机对照试验。5 项（7.8%）为多机构研究。在 33 项研究中，有 24 项（72.7%）研究检查了轮班时间，报告称较短的轮班时间与减少医疗错误、机动车事故和经皮损伤有关。只有 2 项研究评估了保护睡眠时间，并报告说居民对小睡的遵守情况很差。在 33 项研究中描述的夜间轮班涉及连续 5 到 7 个晚上。