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Night Shift Scheduling That Works

January 21, 2020

Written by Clay Smith

Spoon Feed
Scheduling shifts based on the evidence may help us with quality of life and career longevity.

Why does this matter?
Night shifts mess up our circadian rhythms. The disruption from shift work in EM is a driver of burnout. ACEP says such shift work is the primary reason for attrition from EM. Is there a better way to schedule that mitigates some of these effects?

Do nights without going batty
This was two studies in one, a retrospective review of surveys from 31 EM residents; experiment two was a prospective analysis of sleep logs with activity monitoring over 4 weeks from 22 EM residents and attending physicians. Here are the key points and some action steps for creating a better schedule.

  1. Performance is worse at the end of shifts, particularly night shifts. Action: Minimize unnecessary or complex tasks at the end of shifts. Overall minimization of end of shift tasks is important.

  2. Sleep duration and difficulty was greatest on night shift. Action: Napping during or after nights shifts before driving should be an option (not so sure how napping during a night shift would work…).

  3. Action: A pay differential for night shifts to offset need for “moonlighting” is a way to reduce workload.

  4. Action: Scheduling an earlier from later work time (phase advances) and large adjustments (transitioning to a shift more than 6 h away from the current one in < 72 h) should be avoided when possible.

  5. Action: If staffing permits, allowing 4 hour overlap in shift start times would allow an easier transition among shift types, reduce number of staff turning over at once, and reduce end of shift fatigue.

  6. Action: Scheduling a forward rotation in shift times is less disruptive than backward.

  7. Action: Limiting transitions between nights and day shifts helps.

  8. Action: Reducing the number of night shifts in a row reduces cumulative sleep deprivation.

  9. Chronotype matters – morning-people tend to sleep better than night-owls when on day shifts; night-owls tend to sleep better than morning-people when on night shifts. Action: See if you have some night-owls that prefer night shifts or late shifts.

Circadian Profile of an Emergency Medicine Department: Scheduling Practices and Their Effects on Sleep and Performance. J Emerg Med. 2019 Nov 21. pii: S0736-4679(19)30839-X. doi: 10.1016/j.jemermed.2019.10.007. [Epub ahead of print]

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What are your thoughts?