Original Article
Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns
N Engl J Med 2005; 352:125-134January 13, 2005
- Abstract
Background
Long work hours and work shifts of an extended duration (≥24 hours) remain a hallmark of medical education in the United States. Yet their effect on health and safety has not been evaluated with the use of validated measures.
Methods
We conducted a prospective nationwide, Web-based survey in which 2737 residents in their first postgraduate year (interns) completed 17,003 monthly reports that provided detailed information about work hours, work shifts of an extended duration, documented motor vehicle crashes, near-miss incidents, and incidents involving involuntary sleeping.
Results
The odds ratios for reporting a motor vehicle crash and for reporting a near-miss incident after an extended work shift, as compared with a shift that was not of extended duration, were 2.3 (95 percent confidence interval, 1.6 to 3.3) and 5.9 (95 percent confidence interval, 5.4 to 6.3), respectively. In a prospective analysis, every extended work shift that was scheduled in a month increased the monthly risk of a motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly risk of a crash during the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). In months in which interns worked five or more extended shifts, the risk that they would fall asleep while driving or while stopped in traffic was significantly increased (odds ratios, 2.39 [95 percent confidence interval, 2.31 to 2.46] and 3.69 [95 percent confidence interval, 3.60 to 3.77], respectively).
Conclusions
Extended-duration work shifts, which are currently sanctioned by the Accreditation Council for Graduate Medical Education, pose safety hazards for interns. These results have implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.
Media in This Article
Figure 1
Flow Chart of Participation in the Study.Figure 2
Weekly Hours That Interns Worked as a Percentage of Reported Weeks.Article Activity
- Article
Residents in their first postgraduate year (interns) in the United States frequently work shifts of an extended duration (≥24 hours), a practice that results in long workweeks.1,2 Both the number and the distribution of work hours can affect sleep, productivity, and safety.3 The risk of fatigue-related crashes, a leading cause of truck crashes that have been fatal to the driver in the United States,4,5 increases markedly as a function of truckers' consecutive driving hours.6 Despite long-standing concerns regarding the effects of work hours on performance and safety among postgraduate physicians,7-10 prior studies have not directly associated safety outcomes with such a specific characteristic of their work schedule.
To address this issue, we administered a monthly Web-based questionnaire to interns nationwide to investigate the association between validated work hours, extended work shifts, and driving safety. Assessment of driving safely included documented motor vehicle crashes, near-miss incidents, incidents involving falling asleep while driving, and incidents involving falling asleep while stopped in traffic.
Methods
Data Collection
In April 2002, advertisements announcing the Harvard Work Hours, Health, and Safety study and offering the chance of a monetary incentive for participation were sent by e-mail to people who were matched to a residency by the National Resident Matching Program and to graduates of U.S. medical schools. The advertisement that was used is contained in the Supplementary Appendix (available with the full text of this article at www.nejm.org). Thereafter, responses to detailed questions regarding work hours, shifts of extended duration (≥24 hours), motor vehicle crashes, near-miss incidents (near-miss motor vehicle crashes in which property damage or bodily harm was narrowly avoided), and incidents of involuntary sleeping were collected monthly through May 2003, when responses regarding the overall first postgraduate year were also collected. Although this report addresses only data regarding extended shifts, motor vehicle crashes, and near-miss incidents, the questions regarding these exposure and outcome variables were distributed among 60 other questions on the monthly surveys. The Human Research Committee of Brigham and Women's Hospital and Partners HealthCare approved all the study procedures, and all the participants provided electronic written informed consent.
Validation of Work Hours
A random subgroup of participants (7 percent) completed daily work diaries. We validated these diaries in a separate study in which direct observation was used for continuous monitoring of work hours. A very high correlation was found between work hours (r=0.98) and shifts of extended duration (r=1.0) as reported by observers and as recorded in the diaries.11 This work-diary subgroup recorded their work hours for at least 21 out of 28 days and completed the corresponding monthly survey. Pearson's product-moment correlation was used to determine the association between the daily average number of work hours and the number of extended-duration work shifts that were reported in the diary and in the monthly survey.
Documentation Process for Crashes
Participants who reported a motor vehicle crash were requested to provide documentation of the crash. A police report, an insurance claim, an auto-repair record, a medical record, a photograph of the damaged vehicle, or a written description of the crash was accepted as documentation. For participants who did not complete the year-end survey, no additional crashes were identified, either through a search of the Social Security Death Index or through inquiries to the interns' designated emergency contacts.
Statistical Analysis
We used two independent techniques to quantify exposure and to assess relative risk. First, the subgroup of crashes and near-miss incidents that occurred on the commute from work was analyzed with the use of a within-person case-crossover design. For each participant, we assessed the number and proportion of crashes and near-miss incidents that had occurred after an extended work shift, as compared with a shift that was not extended. The Mantel–Haenszel test (with each subject as a separate stratum) was used to calculate the odds ratio for crashes and near-miss incidents that occurred after an extended work shift as compared with a nonextended shift.12 Second, to address potential reporting bias (because both the crashes and the number of extended shifts were reported in each monthly survey), we also prospectively assessed whether the mean monthly number of scheduled extended shifts (collected on the baseline survey) was associated with the subsequent occurrence of motor vehicle crashes as reported on the monthly surveys. We then used Poisson regression analysis that was adjusted for age and sex to determine whether the mean monthly number of scheduled extended shifts was associated with the occurrence of crashes. For each participant, the time at risk for the Poisson regression was considered to be the number of monthly surveys that each participant completed.
A case-crossover analysis was used to determine whether the number of extended shifts that interns worked per month was associated with incidents of falling asleep while driving or while stopped in traffic. The Mantel–Haenszel test was used to calculate odds ratios. The case-crossover study design eliminated the need to account for potential confounders, such as differences in age, sex, commuting time or distance, or medical specialty, since participants served as their own controls.13 All data are reported as means ±SD. All odds ratios are reported with 95 percent confidence intervals; all P values are two-sided. Additional information about the methods used is provided in the Supplementary Appendix.
Results
A total of 3429 interns volunteered to participate in the study. Of those, 2737 (80 percent) completed the baseline survey and were thus deemed the study cohort. Each month, an average of 1548±376 surveys were completed. Ninety-three percent of the study cohort completed at least one monthly survey and were eligible for the analysis of crashes and near-miss incidents; 82 percent completed at least two monthly surveys and were thus eligible to be included in all analyses (Figure 1Figure 1
Flow Chart of Participation in the Study.). We collected a total of 19,740 surveys, including 2737 baseline surveys and 17,003 monthly surveys.Demographic Data
The demographic characteristics of the study participants were similar to those of all interns matched through the National Resident Matching Program in 2002. Of the participants, 53 percent were female, with a mean age of 28.0±3.9 years; 79 percent were in medical specialties, 11 percent in surgical specialties, and 10 percent in other or nonspecified specialties; and 85 percent were graduates of U.S. medical schools. Among all interns in 2002, 41 percent were female, with a mean age of 30.2 years; 88 percent were in medical specialties and 12 percent in surgical specialties; and 74 percent were graduates of U.S. medical schools. Sixty-nine percent of the study participants commuted by car, and their average weekly commute was 91.6±96.2 miles, with 4.4±3.4 hours spent each week commuting.
Validation
Pearson's correlation coefficient for the number of hours reported on the monthly surveys (249.8±75.3 hours) versus the actual number of hours worked, as indicated by daily work diaries completed by a subgroup of 192 participants (244.0±69.3 hours), was 0.76 (P<0.001). Likewise, the number of extended work shifts reported on the monthly surveys (3.6±3.3) was highly correlated with the number of extended work shifts reported in the daily diaries completed by 40 participants (3.5±2.8; r=0.94, P<0.001) (Figure 1).
Work Hours
Interns averaged 70.7±26.0 hours in the hospital weekly; they were awake 67.4±24.4 of those hours and asleep 3.2±4.2 hours (Figure 2Figure 2
Weekly Hours That Interns Worked as a Percentage of Reported Weeks.). They reported that they spent an additional 3.9±5.0 hours per week working or studying outside the hospital, classroom, or workplace related to their program and that they spent 0.1±1.6 hours per week working at a job outside their program. Interns averaged 6.5±4.0 days off per month, including weekends, holidays, and allocated time off.Extended Work Shifts
The mean monthly number of extended work shifts that were reported was 3.9±3.4, with an average duration of 32.0±3.7 hours. The mean number of scheduled monthly shifts of extended duration correlated significantly with the mean number of extended shifts reported on the monthly surveys for participants who completed all 12 surveys (r=0.71, P<0.001). On 86 percent of monthly surveys, participants reported having worked extended shifts without any night-float coverage (the assignment of another physician to take calls for the on-call participant during an overnight shift for a period of time so that the participant could rest). On only 7 percent of the surveys did they report having had night-float coverage on all extended shifts, and on another 7 percent of the surveys, they reported having had some night-float coverage. Of those reporting night-float coverage, the average number of hours of night-float coverage per extended shift was 7.3±3.3 hours. The average number of sleep hours per extended shift for those with night-float coverage was significantly greater than the number for those without night-float coverage (3.2±1.6 hours vs. 2.6±1.7 hours; t=21.3; P<0.001). The number of sleep hours during extended shifts is shown in Figure 3Figure 3
Hours That Interns Slept during Extended Shifts as a Percentage of Monthly Surveys..The largest number of continuous hours that interns reported that they were physically at work averaged 27.6±10.5 hours (Figure 4AFigure 4
Longest Reported Shifts at Work.). Although a quarter of the interns reported that their longest shift did not exceed 16 hours, the modal length of the longest shift worked for the remaining three quarters of the interns was 33 to 36 hours. The largest number of hours that interns remained continuously awake averaged 25.3±8.3 hours, with a subgroup remaining continuously awake much longer (Figure 4D), indicating that extended work shifts of 48 to 84 hours still occurred in some residency programs, presumably on weekends.Motor Vehicle Crashes
A total of 320 motor vehicle crashes were reported, including 133 that were consequential (i.e., crashes leading to treatment in an emergency department, property damage of $1,000 or greater, the filing of a police report, or a combination of these factors); 131 of the 320 crashes occurred on the commute from work. Documentation was obtained for 82 percent of all crashes. The risk of either a crash or a near-miss incident was significantly greater if the intern was commuting from work after an extended shift than it was after a nonextended shift. The Mantel–Haenszel odds ratio was 2.3 (95 percent confidence interval, 1.6 to 3.3) for motor vehicle crashes (χ2=21.4, with 1 df; P<0.001) and 5.9 (95 percent confidence interval, 5.4 to 6.3) for near-miss incidents (χ2=2419.5, with 1 df; P<0.001) (Table 1Table 1
Risk of Motor Vehicle Crashes and Near-Miss Incidents after Extended Shifts.). To address possible reporting bias, we calculated these ratios for the 682 interns who completed all 12 monthly surveys, and the results were similar: 44 crashes during the commute from work (odds ratio, 2.5; 95 percent confidence interval, 1.4 to 4.7) and 663 near-miss incidents (odds ratio, 5.5; 95 percent confidence interval, 4.8 to 6.3). Crashes that occurred after extended shifts and those that occurred after nonextended shifts followed similar temporal patterns for both the time of day and the day of the week (Figure 1 of the Supplementary Appendix).Every extended shift that was scheduled per month increased the monthly rate of any motor vehicle crash by 9.1 percent (95 percent confidence interval, 3.4 to 14.7 percent) and increased the monthly rate of a crash on the commute from work by 16.2 percent (95 percent confidence interval, 7.8 to 24.7 percent). The odds ratios for falling asleep while driving or while stopped in traffic increased significantly as the number of extended shifts worked per month increased (Table 2Table 2
Odds Ratios for Falling Asleep while Driving or while Stopped in Traffic, According to the Monthly Number of Extended Work Shifts.).Discussion
We found that the odds that interns will have a documented motor vehicle crash on the commute after an extended work shift were more than double the odds after a nonextended shift. Near-miss incidents were more than five times as likely to occur after an extended work shift as they were after a nonextended shift. These findings, which are of particular concern because motor vehicle crashes are the leading cause of death in this age group,14 are consistent with the findings that sleep deprivation degrades performance5,15,16 and that the number of fatigue-related crashes increases in proportion to the time spent on task.6 Given the percentage of interns in our study who commuted by car (69 percent), these data suggest that implementation of a work schedule for interns without any extended shifts11 could prevent a substantial number of crashes.
We also found, with the use of a validated survey instrument, that in the 2002–2003 academic year, 46.2 percent of the weeks that interns worked averaged more than 80 work hours, and 11.0 percent of the weeks they worked averaged more than 100 work hours. These findings are consistent with earlier studies of self-reported work hours.1 Overall, interns reported that they were awake during 96.1 percent of their hours in the hospital. Contrary to conventional wisdom, interns whose weekly work hours exceeded the equivalent of three full-time jobs (i.e., >120 hours per week) slept just as small a percentage of their time in the hospital as did interns working the most common weekly work hours (81 to 100 hours per week).
These findings reveal that the schedule of present-day resident physicians in the United States is far different from that of resident physicians 60 years ago who lived, worked, and slept in the hospital in order to follow the evolution of the illnesses of patients who were hospitalized for extended periods.17 Currently, interns work extended shifts with minimal sleep in the hospital while caring for patients who are hospitalized during the most acute phase of their illness. Yet interns are still anachronistically described as being “on call” during these extended shifts, even though they are working 96 percent of the time. In today's climate of pressure to reduce the length of patients' hospital stays, 85.6 percent of monthly surveys indicated that interns slept four hours or less while working on extended shifts.
Given that there are 168 hours in a week, the opportunity for sleep is severely limited among interns who are working more than 100 hours per week. Their ability to sleep for the recommended eight hours per night becomes physically impossible and inevitably leads to progressively more severe chronic sleep restriction, with its attendant consequences.15-18
Most interns in our study routinely worked more than 30 consecutive hours, a schedule that involved at least one night of acute sleep deprivation. It is remarkable that there were 275 reports from interns who worked more than 40 continuous hours, a shift that necessarily involved the intrusion of acute sleep deprivation into a second consecutive night. Given the 1400 person-years of data collected, extrapolation of these results to the wider population of 102,577 person-years worked by residents in U.S. hospitals in 2002–200319 suggests that physicians in training worked approximately 20,000 extended shifts that exceeded 40 consecutive hours while caring for patients. Of note, extrapolation from our data suggests that 10 percent of these shifts may have exceeded 64 continuous hours in duration, indicating potential intrusion of acute sleep deprivation into a third consecutive night on a single work shift.
Our study has a number of limitations. First, even though we had a response rate of 80 percent from interns who volunteered to participate, those who did may not be representative. However, the distributions of age and residency-program type of our participants were comparable to those in the entire National Resident Matching Program. Notably, participants were not apprised of the study hypotheses, and the questions regarding our primary variables of exposure (work shifts of extended duration) and outcome (motor vehicle crashes) were validated and documented, respectively, and distributed among numerous other questions. As such, we believe that it is highly improbable that the participants — even those with a specific interest in the work hours of residents — could have deliberately affected the specific data regarding crash and near-miss rates that we report here. Second, the case-crossover analysis cannot account for the contribution of within-person factors that may have been covariates with exposure status. For example, interns probably had higher average blood levels of caffeine during their commutes after extended shifts as compared with commutes after nonextended shifts — a factor that may have had an effect on our results.20 However, even if extended shifts were to elicit behavior that affected risk, this elicited behavior would not obviate the potential causal relationship between exposure to extended shifts and motor vehicle crashes. Third, our prospective analysis may have been confounded by uncontrolled covariates, although the results of that analysis were consistent with the results of our case-crossover analysis, which was free of such confounders because each participant served as his or her own control. Fourth, by collecting data on a monthly basis, we attempted to reduce, but could not eliminate, the effect of recall bias. Fifth, reporting bias could have confounded the results of our case-crossover analysis if participants preferentially completed monthly surveys after having had a motor vehicle crash. However, the prospective analysis, which was relatively free of this type of reporting bias, yielded similar results. Furthermore, case-crossover analysis of the subgroup of participants who completed all the surveys yielded an odds ratio of 2.5 (95 percent confidence interval, 1.4 to 4.7) for having a motor vehicle crash after working an extended shift (as compared with a nonextended shift) that was similar to that of the entire study population (odds ratio, 2.3; 95 percent confidence interval, 1.6 to 3.3). Overall, the convergence of our crash results with the use of two independent methods of exposure-data collection strongly supports our conclusion that an increased risk of crashes and near-miss incidents is associated with working extended shifts.
The increased rate of actual motor vehicle crashes and near-miss incidents during interns' commutes after extended work shifts that we have documented has legal implications, since drivers in both the United States21,22 and Great Britain23 have already been convicted of vehicular homicide for driving when impaired by sleepiness. Furthermore, the state of New Jersey has recently amended its vehicular-homicide statute to add to the definition of reckless driving “driving after having been without sleep for a period in excess of 24 consecutive hours,” a revision that explicitly subjects drivers in that state to a conviction of criminal homicide under such circumstances.24 Similar legislation is pending in New York, Massachusetts, and Michigan. Moreover, appeals courts in two states have ruled that an employer's responsibility for fatigue-related crashes can continue even after an employee has left work, similar in concept to the liability incurred by people who serve alcohol to drivers who are subsequently involved in alcohol-related motor vehicle crashes.25,26 The Department of Surgery at the University of Michigan has taken the initiative to address this concern by offering round-trip taxicab vouchers to surgical residents on request (Mulholland M: personal communication). However, the impairment of judgment about one's own ability to perform after sleep deprivation15 could limit the use of such transportation vouchers by residents, even when they are available.
In 2005, the current work-hour guidelines of the Accreditation Council for Graduate Medical Education still allow interns in the United States to work 30 consecutive hours every other shift. This practice has recently been prohibited by the European Union, which stipulates a “minimum daily rest period of 11 consecutive hours per 24-hour period” (thereby limiting the duration of shifts for all physicians to 13 hours), although the regulation includes some exceptions and a controversial opt-out provision.27 Our data indicate that scheduling physicians to work such extended shifts, which our group has recently shown to increase the risk of failures of attention11 and serious medical errors,28 poses a serious and preventable safety hazard for them and other motorists. These results have important implications for scheduling practices in medical-residency programs.
Supported by grants from the National Institute for Occupational Safety and Health (1 R01 OH07567), which provided a certificate of confidentiality for data protection, and by the Agency for Healthcare Research and Quality (RO1 HS12032). Dr. Cronin is the recipient of a National Research Service Award from the Agency for Healthcare Research and Quality (F32 HS14130); Drs. Cronin and Barger are the recipients of National Heart, Lung, and Blood Institute fellowships in the Program of Training in Sleep, Circadian, and Respiratory Neurobiology at Brigham and Women's Hospital (T32 HL079010); and Dr. Ayas is the recipient of a New Investigator Award from the Canadian Institutes of Health Research/British Columbia Lung Association, a Michael Smith Foundation Scholar Award, and a Departmental Scholar Award from the University of British Columbia; Dr. Czeisler is supported in part by the National Space Biomedical Research Institute through the National Aeronautics and Space Administration (NCC9-58).
We are indebted to the interns who took time from their busy work schedules to participate in this study; to the National Resident Matching Program and the Association of American Medical Colleges (especially Jordan J. Cohen, Paul Jolly, and the Division of Medical School Services and Studies) for their assistance with recruitment; to DeWitt C. Baldwin and Steven R. Daugherty for their assistance in designing the questionnaires; to Tim Ayas and Sharlene Hudson for their help in reviewing the questionnaire; to Michael Schulzer for his assistance with data analysis; to Steven W. Lockley for his assistance with the study design and data interpretation; to Darrell Drovnich and the National Sleep Foundation for information about legislation regarding driving while drowsy; to Joseph B. Martin for his support and encouragement; to Cherelyn Werre and Mohammed Rasheed at Pearson NCS for their commitment to this project; and to K.C. Malvey, Patrick Glew, and Christian Lima for their assistance in crash documentation and validation procedures.
Source Information
From the Division of Sleep Medicine (L.K.B., B.E.C., N.T.A., J.W.C., C.A.C.) and the Channing Laboratory (B.R., F.E.S.), Department of Medicine, Brigham and Women's Hospital; and the Division of Sleep Medicine, Harvard Medical School (L.K.B., N.T.A., J.W.C., C.A.C.) — both in Boston; and the Department of Medicine, University of British Columbia; and the Center for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute — both in Vancouver, B.C., Canada (N.T.A.).
Address reprint requests to Dr. Czeisler at the Division of Sleep Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Ave., Boston, MA 02115, or at caczeisler@hms.harvard.edu.
- References
References
1
Baldwin DC Jr ,Daugherty SR ,Tsai R ,Scotti MJ Jr . A national survey of residents' self-reported work hours: thinking beyond specialty. Acad Med 2003;78:1154-1163
CrossRef | Web of Science | Medline2
Brotherton SE ,Simon FA ,Etzel SI . US graduate medical education, 2001-2002: changing dynamics. JAMA 2002;288:1073-1078
CrossRef | Web of Science | Medline3
Czeisler CA ,Moore-Ede MC ,Coleman RM . Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. Science 1982;217:460-463
CrossRef | Web of Science | Medline4
Safety study: fatigue, alcohol, other drugs, and medical factors in fatal-to-the-driver heavy truck crashes. Vol. 1. 1990. Washington, D.C.: National Transportation Safety Board, 1990. (NTSB publication no. SS-90/01.)
5
Dement WC . The perils of drowsy driving. N Engl J Med 1997;337:783-784
Full Text | Web of Science | Medline6
Department of Transportation 7
Friedman RC ,Bigger JT ,Kornfield DS . The intern and sleep loss. N Engl J Med 1971;285:201-203
Full Text | Web of Science | Medline8
Whang EE ,Perez A ,Ito H ,Mello MM ,Ashley SW ,Zinner MJ . Work hours reform: perceptions and desires of contemporary surgical residents. J Am Coll Surg 2003;197:624-630
CrossRef | Web of Science | Medline9
Niederee MJ ,Knudtson JL ,Byrnes MC ,Helmer SD ,Smith RS . A survey of residents and faculty regarding work hour limitations in surgical training programs. Arch Surg 2003;138:663-669
CrossRef | Web of Science | Medline10
Daugherty SR ,Baldwin DC Jr ,Rowley BD . Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA 1998;279:1194-1199
CrossRef | Web of Science | Medline11
Lockley SW ,Cronin JW ,Evans EE , et al. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med 2004;351:1829-1837
Full Text | Web of Science | Medline12
Rosner BA. Fundamentals of biostatistics. 5th ed. Pacific Grove, Calif.: Brooks/Cole, 2000.
13
Maclure M ,Mittleman MA . Should we use a case-crossover design? Annu Rev Public Health 2000;21:193-221
CrossRef | Web of Science | Medline14
Subramanian R. Motor vehicle traffic crashes as a leading cause of death in the United States, 2001. Washington, D.C.: Department of Transportation, National Highway Safety Administration, 2003. (DOT HS 809 695.)
15
Van Dongen HP ,Maislin G ,Mullington JM ,Dinges DF . The cumulative cost of additional wakefulness: dose-response effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. Sleep 2003;26:117-126[Erratum, Sleep 2004;27:600.]
Web of Science | Medline16
Belenky G ,Wesensten NJ ,Thorne DR , et al. Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: a sleep dose-response study. J Sleep Res 2003;12:1-12
CrossRef | Web of Science | Medline17
Cassell EJ . Historical perspective of medical residency training: 50 years of changes. JAMA 1999;281:1231-1231
CrossRef | Web of Science | Medline18
Spiegel K ,Leproult R ,Van Cauter E . Impact of sleep debt on metabolic and endocrine function. Lancet 1999;354:1435-1439
CrossRef | Web of Science | Medline19
Accreditation Council for Graduate Medical Education. Number of programs by specialty. (Accessed December 17, 2004, at http://www.acgme.org/adspublic/reports/specialty_prognum.asp.)
20
Wyatt JK ,Cajochen C ,Ritz-De Cecco A ,Czeisler CA ,Dijk D-J . Low dose repeated caffeine administration for circadian-phase-dependent performance degradation during extended wakefulness. Sleep 2004;27:374-381
Web of Science | Medline21
Massachusetts v. Salvaggio, N. Berkshire County (Mass. Dist. Ct. 1994) (No. 9428CR000504).
22
Florida v. Rosario (10th Cir. 2001) (No. CF 9903659A-XX.)
23
Regina v. Gary Neil Hart. Royal Courts of Justice, Strand, London, WC2, 2003. (No. 200200123/y4.)
24
Pub. L. 2003, c. 143, eff. Aug. 5, 2003 (amending N.J.S.2C:11-5 to include driving while fatigued as recklessness under vehicular homicide statute).
25
Roberston v. LeMaster, 301 S.E.2d 563 (W. Va. 1983).
26
Faverty v. McDonald's Restaurants of Oregon, 892 P.2d 703 (Oreg. 1995).
27
European Working Time Directive. (Accessed December 17, 2004, at http://www.incomesdata.co.uk/information/worktimedirective.htm#Article3.)
28
Landrigan CP ,Rothschild JM ,Cronin JW , et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 2004;351:1838-1848
Full Text | Web of Science | Medline
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CrossRef20
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CrossRef21
Jennifer McDonald, Dipali Patel, Gregory Belenky. 2011. Sleep and Performance Monitoring in the Workplace. , 775-783.
CrossRef22
Kathryn J. Reid, Lori L. McGee-Koch, Phyllis C. Zee. 2011. Cognition in circadian rhythm sleep disorders. , 3-20.
CrossRef23
Christopher L. Drake, Kenneth P. Wright. 2011. Shift Work, Shift-Work Disorder, and Jet Lag. , 784-798.
CrossRef24
Jane B Lemaire, Jean E Wallace, Kelly Dinsmore, Delia Roberts. (2011) Food for thought: an exploratory study of how physicians experience poor workplace nutrition. Nutrition Journal 10:1, 18
CrossRef25
James K. Walsh, William C. Dement, David F. Dinges. 2011. Sleep Medicine, Public Policy, and Public Health. , 716-724.
CrossRef26
Pierre Philip, Patricia Sagaspe, J. Taillard. 2011. Drowsy Driving. , 769-774.
CrossRef27
Torbjörn Åkerstedt, Pierre Philip, Aurore Capelli, Göran Kecklund. 2011. Sleep loss and accidents—Work hours, life style, and sleep pathology. , 169-188.
CrossRef28
Hans P.A. Van Dongen, Steven R. Hursh. 2011. Fatigue, Performance, Errors, and Accidents. , 753-759.
CrossRef29
Igor RADUN, Jussi OHISALO, Jenni RADUN, Göran KECKLUND. (2011) Night Work, Fatigued Driving and Traffic Law: The Case of Police Officers. Industrial Health 49:3, 389-392
CrossRef30
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CrossRef31
Gregory O'Grady, Benjamin Loveday, Simon Harper, Brandon Adams, Ian D. Civil, Matthew Peters. (2010) Working hours and roster structures of surgical trainees in Australia and New Zealand. ANZ Journal of Surgery 80:12, 890-895
CrossRef32
Cor J Kalkman. (2010) Handover in the perioperative care process. Current Opinion in Anaesthesiology 23:6, 749-753
CrossRef33
PATRICIA SAGASPE, JACQUES TAILLARD, VIRGINIE BAYON, EMMANUEL LAGARDE, NICHOLAS MOORE, JACQUES BOUSSUGE, GUILLAUME CHAUMET, BERNARD BIOULAC, PIERRE PHILIP. (2010) Sleepiness, near-misses and driving accidents among a representative population of French drivers. Journal of Sleep Research 19:4, 578-584
CrossRef34
(2010) Excessive sleepiness: under-recognized and essential marker for sleep/wake disorder management. Current Medical Research and Opinion 26:s2, S3-S27
CrossRef35
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CrossRef36
Tracy L. Skaer, David A. Sclar. (2010) Economic Implications of Sleep Disorders. PharmacoEconomics 28:11, 1015-1023
CrossRef37
(2010) Emergency Physician Shift Work. Annals of Emergency Medicine 56:4, 451
CrossRef38
Andreas Valentin. (2010) The importance of risk reduction in critically ill patients. Current Opinion in Critical Care 16:5, 482-486
CrossRef39
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CrossRef40
Scott Grady, Daniel Aeschbach, Kenneth P Wright, Charles A Czeisler. (2010) Effect of Modafinil on Impairments in Neurobehavioral Performance and Learning Associated with Extended Wakefulness and Circadian Misalignment. Neuropsychopharmacology 35:9, 1910-1920
CrossRef41
Gordon F. Murray. (2010) “Though Medicine Can Be Learned, It Cannot Be Taught”—The First 100 Years: Flexnerian Competency 2010. The Annals of Thoracic Surgery 90:1, 1-10
CrossRef42
J. F. Bion, T. Abrusci, P. Hibbert. (2010) Human factors in the management of the critically ill patient. British Journal of Anaesthesia 105:1, 26-33
CrossRef43
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CrossRef44
2010. Productivity in a Healthy and Safe Work Environment. , 223-262.
CrossRef45
P. Angerer, R. Petru. (2010) Schichtarbeit in der modernen Industriegesellschaft und gesundheitliche Folgen. Somnologie - Schlafforschung und Schlafmedizin 14:2, 88-97
CrossRef46
A. Rodenbeck, G. Hajak. (2010) Das Schichtarbeitersyndrom. Somnologie - Schlafforschung und Schlafmedizin 14:2, 105-110
CrossRef47
Leonie Marcus, Donald Liew, Jonathan Knott. (2010) The effect of nightshift on emergency registrars' clinical skills. Emergency Medicine Australasia 22:3, 211-215
CrossRef48
&NA;. (2010) Risks of Complications by Attending Physicians After Performing Nighttime Procedures. Survey of Anesthesiology 54:3, 153-154
CrossRef49
Nelson B. Powell, Jason K.M. Chau. (2010) Sleepy Driving. Medical Clinics of North America 94:3, 531-540
CrossRef50
P. Daniel Patterson, Brian P. Suffoletto, Douglas F. Kupas, Matthew D. Weaver, David Hostler. (2010) Sleep Quality and Fatigue Among Prehospital Providers. Prehospital Emergency Care 14:2, 187-193
CrossRef51
Daniel Shine, Ellen Pearlman, Brendan Watkins. (2010) Measuring Resident Hours by Tracking Interactions with the Computerized Record. The American Journal of Medicine 123:3, 286-290
CrossRef52
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CrossRef53
Abay G. Asfaw, P. Timothy Bushnell, Tapas K. Ray. (2010) Relationship of work injury severity to family member hospitalization. American Journal of Industrial Medicinen/a-n/a
CrossRef54
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CrossRef55
(2009) CardioPulse Articles. European Heart Journal 30:23, 2817-2828
CrossRef56
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CrossRef57
Lenny L
pez, Arthur J. Dyck. (2009) EDUCATING PHYSICIANS FOR MORAL EXCELLENCE IN THE TWENTY-FIRST CENTURY. Journal of Religious Ethics 37:4, 651-668
CrossRef58
Jean E Wallace, Jane B Lemaire, William A Ghali. (2009) Physician wellness: a missing quality indicator. The Lancet 374:9702, 1714-1721
CrossRef59
Steven H. Rose, Timothy B. Curry. (2009) Fatigue, Countermeasures, and Performance Enhancement in Resident Physicians. Mayo Clinic Proceedings 84:11, 955-957
CrossRef60
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CrossRef61
(2009) Residents' Work Hours. New England Journal of Medicine 361:9, 928-930
Full Text62
F.P. Cappuccio. (2009) 'Hospital at Night' improves outcomes: does the evidence support opinions?. QJM 102:8, 583-584
CrossRef63
Steven L. Clark. (2009) Sleep deprivation: implications for obstetric practice in the United States. American Journal of Obstetrics and Gynecology 201:2, 136.e1-136.e4
CrossRef64
David W. Bates. (2009) Fatigue, Resident Work Hours, and Safety. Medical Care 47:7, 711-713
CrossRef65
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CrossRef66
Barbara J. Wilhelm, Anja Widmann, Wilhelm Durst, Christian Heine, Gerhard Otto. (2009) Objective and quantitative analysis of daytime sleepiness in physicians after night duties. International Journal of Psychophysiology 72:3, 307-313
CrossRef67
Nuckols, Teryl K., Bhattacharya, Jay, Wolman, Dianne Miller, Ulmer, Cheryl, Escarce, José J., . (2009) Cost Implications of Reduced Work Hours and Workloads for Resident Physicians. New England Journal of Medicine 360:21, 2202-2215
Full Text68
James A. O'Neill. (2009) Surgical Education: Foundations and Values. Journal of the American College of Surgeons 208:5, 653-662
CrossRef69
Soufiane Boufous, Ann Williamson. (2009) Factors affecting the severity of work related traffic crashes in drivers receiving a worker's compensation claim. Accident Analysis & Prevention 41:3, 467-473
CrossRef70
E. Montero Ruiz, C. Hernández Ahijado, F. García Sánchez, J.C. Ramos Ramos. (2009) Reflexiones sobre el papel del médico en la guardia intrahospitalaria. Revista Clínica Española 209:4, 185-188
CrossRef71
Laura K. Barger, Steven W. Lockley, Shantha M. W. Rajaratnam, Christopher P. Landrigan. (2009) Neurobehavioral, health, and safety consequences associated with shift work in safety-sensitive professions. Current Neurology and Neuroscience Reports 9:2, 155-164
CrossRef72
F. P. Cappuccio, A. Bakewell, F. M. Taggart, G. Ward, C. Ji, J. P. Sullivan, M. Edmunds, R. Pounder, C. P. Landrigan, S. W. Lockley, E. Peile, . (2009) Implementing a 48 h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. QJM 102:4, 271-282
CrossRef73
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CrossRef74
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CrossRef75
Allard E. Dembe. (2009) Ethical Issues Relating to the Health Effects of Long Working Hours. Journal of Business Ethics 84:S2, 195-208
CrossRef76
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CrossRef77
Yoo-Sam Chung. (2009) Sleep Medicine and Public Health. Korean Journal of Otorhinolaryngology-Head and Neck Surgery 52:9, 713
CrossRef78
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CrossRef79
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CrossRef80
Lindsay D. Friesen, Arpana R. Vidyarthi, Robert B. Baron, Patricia P. Katz. (2008) Factors Associated with Intern Fatigue. Journal of General Internal Medicine 23:12, 1981-1986
CrossRef81
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CrossRef82
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CrossRef83
Mark R. Smith, Erin E. Cullnan, Charmane I. Eastman. (2008) Shaping the light/dark pattern for circadian adaptation to night shift work. Physiology & Behavior 95:3, 449-456
CrossRef84
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CrossRef85
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CrossRef86
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CrossRef87
Ahmad-Reza Noroozi, Rawle F. Philbert. (2008) Residents' Perception of the Impact of the Bell Commission in Oral Surgery Training: An Initial Study. Journal of Oral and Maxillofacial Surgery 66:7, 1329-1334
CrossRef88
F. Crummy, P. A. Cameron, P. Swann, T. Kossmann, M. T. Naughton. (2008) Prevalence of sleepiness in surviving drivers of motor vehicle collisions. Internal Medicine Journal 0:0, 080519174841356-???
CrossRef89
Seth A. Capello, Hitendra R. H. Patel, Jean V. Joseph. (2008) Surgical case order does not affect outcomes during robot-assisted radical prostatectomy. Journal of Robotic Surgery 2:1, 25-29
CrossRef90
Sarah I Woodrow, Jason Park, Brian J Murray, Calvin Wang, Mark Bernstein, Richard K Reznick, Stanley J Hamstra. (2008) Differences in the perceived impact of sleep deprivation among surgical and non-surgical residents. Medical Education 42:5, 459-467
CrossRef91
Michelle Janney, Christopher Landrigan. (2008) Improving nurse working conditions: Towards safer models of hospital care. Journal of Hospital Medicine 3:3, 181-183
CrossRef92
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CrossRef93
M CHIRON, M BERNARD, S LAFONT, E LAGARDE. (2008) Tiring job and work related injury road crashes in the GAZEL cohort. Accident Analysis & Prevention 40:3, 1096-1104
CrossRef94
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CrossRef95
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CrossRef96
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CrossRef97
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CrossRef98
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CrossRef99
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CrossRef100
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CrossRef101
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CrossRef102
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CrossRef103
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CrossRef104
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CrossRef105
R STUCKEY, A LAMONTAGNE, M SIM. (2007) Working in light vehicles—A review and conceptual model for occupational health and safety
. Accident Analysis & Prevention 39:5, 1006-1014
CrossRef106
I A Jacobs, M T Podobny, D Bilusich. (2007) One mechanism underlying contrasting health-economy findings. International Journal of Epidemiology 36:4, 929-931
CrossRef107
Patrick Plunkett. (2007) Professionalism and advocacy. European Journal of Emergency Medicine 14:4, 185-187
CrossRef108
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CrossRef109
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CrossRef110
Anne F. Marrelli. (2007) Work diaries. Performance Improvement 46:5, 44-48
CrossRef111
Steven W. Lockley. (2007) Safety considerations for the use of blue-light blocking glasses in shift-workers. Journal of Pineal Research 42:2, 210-211
CrossRef112
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CrossRef113
C. A. Czeisler, J. J. Gooley. (2007) Sleep and Circadian Rhythms in Humans. Cold Spring Harbor Symposia on Quantitative Biology 72:1, 579-597
CrossRef114
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CrossRef115
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CrossRef116
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CrossRef117
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CrossRef118
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CrossRef119
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CrossRef120
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CrossRef121
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CrossRef122
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CrossRef123
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CrossRef124
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CrossRef125
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CrossRef126
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CrossRef127
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CrossRef128
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CrossRef129
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CrossRef130
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CrossRef131
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CrossRef132
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CrossRef133
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CrossRef134
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CrossRef135
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CrossRef136
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CrossRef137
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CrossRef138
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CrossRef139
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CrossRef140
Gary E Friedlaender. (2006) The 80-hour Duty Week. Clinical Orthopaedics and Related Research PAP,
CrossRef141
Francis S. Nuthalapaty, Alissa R. Carver, Elizabeth S. Nuthalapaty, Patrick S. Ramsey. (2006) The perceived impact of duty hour restrictions on the residency environment: A survey of residency program directors. American Journal of Obstetrics and Gynecology 194:6, 1556-1562
CrossRef142
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CrossRef143
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CrossRef144
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CrossRef145
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CrossRef146
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CrossRef147
Sairam Parthasarathy. (2006) Sleep and the medical profession. Current Opinion in Internal Medicine 5:1, 62-67
CrossRef148
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CrossRef149
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CrossRef150
Jonathan R L Schwartz, Thomas Roth. (2006) Shift Work Sleep Disorder. Drugs 66:18, 2357-2370
CrossRef151
J.A. Stockman. (2006) Extended Work Shifts and the Risk of Motor Vehicle Crashes Among Interns. Yearbook of Pediatrics 2006, 308-310
CrossRef152
A VERMA. (2006) Extended Work Shifts and the Risk of Motor Vehicle Crashes Among InternsBarger LK, for the Harvard Work Hours, Health, and Safety Group (Brigham and Women's Hosp, Boston; Harvard Med School, Boston) N Engl J Med 352:125–134, 2005§. Yearbook of Neurology and Neurosurgery 2006, 123-124
CrossRef153
Ralph Lydic, Helen A. Baghdoyan. (2005) Sleep, Anesthesiology, and the Neurobiology of Arousal State Control. Anesthesiology 103:6, 1268-1295
CrossRef154
Eric S. Holmboe, Judith L. Bowen, Michael Green, Jessica Gregg, Lorenzo DiFrancesco, Eileen Reynolds, Patrick Alguire, David Battinelli, Catherine Lucey, Daniel Duffy. (2005) Reforming Internal Medicine Residency Training. A Report from the Society of General Internal Medicine's Task Force for Residency Reform. Journal of General Internal Medicine 20:12, 1165-1172
CrossRef155
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CrossRef156
Sairam Parthasarathy. (2005) Sleep in the intensive care unit: Sleepy doctors and restless patients. Clinical Intensive Care 16:3-4, 129-136
CrossRef157
James B. Burch, Michael G. Yost, Wendy Johnson, Emily Allen. (2005) Melatonin, Sleep, and Shift Work Adaptation. Journal of Occupational and Environmental Medicine 47:9, 893-901
CrossRef158
Jennifer L. Irani, Michelle M. Mello, Stanley W. Ashley, Edward E. Whang, Michael J. Zinner, Elizabeth Breen. (2005) Surgical residents' perceptions of the effects of the ACGME duty hour requirements 1 year after implementation. Surgery 138:2, 246-253
CrossRef159
R. R. Grunstein, N. L. Rogers. (2005) Medical work hours: time for a Maggie's Law for doctoring?. Internal Medicine Journal 35:5, 269-271
CrossRef160
Russell G. Foster, Katharina Wulff. (2005) Science and society: The rhythm of rest and excess. Nature Reviews Neuroscience 6:5, 407-414
CrossRef161
(2005) Post-Call Accidents. New England Journal of Medicine 352:14, 1491-1492
Full Text162
T. M. Pal. (2005) Verkeersongelukken bij arts-assistenten door lange werktijden. Tijdschrift voor Bedrijfs- en Verzekeringsgeneeskunde 13:4, 150-151
CrossRef163
Wylie, C. Dennis, . (2005) Sleep, Science, and Policy Change. New England Journal of Medicine 352:2, 196-197
Full Text
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