How Badly Do We Function After a String of Nights?

August 27, 2024

Written by Caitlin Nicholson

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Residents working in the emergency department were found to do significantly worse on cognitive tests and moral performance after working 5 consecutive night shifts compared to 5 day shifts.

If only they had measured the difference in caffeine consumption…
This prospective crossover study compared results of cognitive testing, psychomotor parameters, and moral performance on residents working 5 consecutive day shifts versus 5 night shifts in the emergency department setting. It also looked at average sleep time and subjective sleepiness. The 27 residents acted as their own controls, with testing after each string of shifts and a 4 week washout period in between. Sleep duration decreased by approximately 30 mins (p=0.034), with an expected increase in subjective sleepiness scores when residents were on night shifts. After 5 night shifts, residents also did significantly worse on working memory testing, inference testing, and moral judgment (p=0.03; p<0.001; p=0.010, respectively). Interestingly, psychomotor and reaction times did not significantly differ. Of note, the residents worked 6 hour shifts during the day versus 12 hour night shifts, with a reduction in patient volume during the night shifts.

How will this change my practice?
This was an interesting, although small, study. I am not someone who thrives during a long string of night shifts, so these findings were in line with my subjective feelings. I am interested to see further studies as current ACEP and ACGME guidelines do not include specific recommendations regarding the number of consecutive night shifts for residents.

Source
Effect of serial night shifts on the cognitive, psychomotor, and moral performance of residents in the department of Emergency Medicine. Acad Emerg Med. 2024 Jul 15. doi: 10.1111/acem.14980. Online ahead of print. PMID: 39007435