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Shiftwork and emergency medical practice

Published online by Cambridge University Press:  21 May 2015

Jason R. Frank  and
Howard Ovens
Jason R. Frank*
Affiliation:
Division of Emergency Medicine, University of Ottawa, and Department of Emergency Medicine, Ottawa Hospital — General Campus, Ottawa, Ont
Howard Ovens
Affiliation:
Mount Sinai Hospital, Toronto, Ont
*
Emergency Department, Ottawa Hospital – General Campus, 501 Smyth Rd., Ottawa ON K1H 8L6[email protected]

Abstract

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Shiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. We conducted a systematic literature review to characterize the effects of shiftwork on physician health, well-being and practice, and to describe rational strategies to mitigate its impact on Canadian emergency physicians.

Keywords

shiftworkemergency medicinephysician healthcircadianschedulessleep error
Type
ED Administration • Administration de la MU
Information
Canadian Journal of Emergency Medicine , Volume 4 , Issue 6 , November 2002 , pp. 421 - 428
Copyright
Copyright © Canadian Association of Emergency Physicians 2002

References

1.Schneider, SM, Hamilton, GC, Moyer, P.Stapczynski, JS.Definition of emergency medicine. Acad Emerg Med 1998;5:348–51.Google Scholar
2.Riggs, LM Jr.A vigorous new specialty. N Engl J Med 1981;304:480–3.Google Scholar
3.Royal College of Physicians and Surgeons of Canada Task Force on Emergency Medicine. Report on emergency medicine. Ottawa (ON): The College; 1988.Google Scholar
4.Moore-Ede, M, Richardson, G.Medical implications of shift work. Ann Rev Med 1985;36:607–17.Google Scholar
5.Costa, G.The impact of shift and night work on health. Appl Ergon 1996; 27(1):9.Google Scholar
6.Gordon, N, Cleary, PD, Parker, CE, Czeisler, CA.The prevalence and health impact of shift work. Am J Public Health 1986;76:1225–8.Google Scholar
7.Siebenaler, MJ, McGovern, PM.Shiftwork consequences and health. AAOHN J 1991;39:558–67.Google Scholar
8.Hall, KN, Wakeman, MA, Levy, RC, Khoury, J.Factors associated with career longevity in residency trained emergency physicians. Ann Emerg Med 1992;21:291–6.Google Scholar
9.Thomas, HA Jr.Circadian rhythms and shift work. Policy and Resource Education Paper. American College of Emergency Physicians; 1994. Available: www.acep.org/1,509,0.html (accessed 2002 Aug 19).Google Scholar
10.Zun, L, Kobernick, M, Howes, DS.Emergency physicians stress and morbidity. Am J Emerg Med 1988;6:370–4.CrossRefGoogle ScholarPubMed
11.Keller, K, Koenig, W.Sources of stress and satisfaction in emergency medicine. J Emerg Med 1989;7:293–9.Google Scholar
12.Waeckerle, JF.Circadian rhythm, shift work, and emergency physicians. Ann Emerg Med 1994;24(5):959–61.Google Scholar
13.Reinhart, MA, Munger, BS, Rund, DA.American Board of Emergency Medicine Longitudinal Study of Emergency Physicians. Ann Emerg Med 1999;33(1):22–32.Google Scholar
14.Whitehead, DC, Thomas, H Jr, Slapper, DR.A rational approach to shift work in emergency medicine [review]. Ann Emerg Med 1992;21(10):1250–8.Google Scholar
15.Olson, CM.Shift work. J Emerg Med 1984;2(1):37–43.CrossRefGoogle ScholarPubMed
16.Jung, F.Shiftwork: its effect on health performance and well-being. AAOHN J 1986;34(4):161–4.Google Scholar
17.Scott, A, LaDou, J.Health and safety in shift workers. In: Zenz, C, editor. Occupational medicine: principles and practical applications. 3rd ed. Chicago: Year Book Medical Publishers; 1994.Google Scholar
18.LaDou, J.Health effects of shift work. West J Med 1982;137:525–30.Google Scholar
19.Rutenfranz, J, Colquhoun, WP, Knauth, P, Ghata, JN.Biomedical and psychosocial aspects of shift work. Scand J Work Environ Health 1977;3:165–82.Google Scholar
20.Dorevitch, S, Forest, L.The occupational hazards of emergency physicians. Am J Emerg Med 2000;18:300–11.Google Scholar
21.Smolensky, MH.The chronoepidemiology of occupational health and shiftwork. In: Reinberg, A, et al, editors. Advances in biosciences. Vol 30. Night and shiftwork biological and social aspects. New York (NY): Pergamon Press; 1980. p. 51–67.Google Scholar
22.Winget, C, Hughes, L, LaDou, J.Physiological effects of rotational shift working. J Occup Med 1978;20:204–10.Google Scholar
23.Moore-Ede, MC, Czeisler, CA, Richardson, GS.Circadian timekeeping in health and disease. Part 1. Basic properties of circadian pacemakers. N Engl J Med 1983;309:468–76.Google Scholar
24.Michaels, HE.Night shift work. Ann Emerg Med 1984;13 (3):201–2.CrossRefGoogle ScholarPubMed
25.Akerstedt, T.Sleepiness at work: effects of irregular work hours. In: Monk, T, editor. Sleep, sleepiness, and performance. Chichester (UK): John Wiley and Sons; 1991.Google Scholar
26.Moore-Ede, MC, Czeisler, CA, Richardson, GS.Circadian timekeeping in health and disease. Part 2. Clinical implications of circadian rhythmicity. N Engl J Med 1983;309:530–6.CrossRefGoogle ScholarPubMed
27.Akerstedt, T, Torswall, T.Shift work, shift-dependent well-being and individual differences. Ergonomics 1981;24:269.CrossRefGoogle ScholarPubMed
28.Smith-Coggins, R, Rosekind, MR, Hurd, S, Buccino, KR.Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994;24:928–34.Google Scholar
29.Rosa, RR, Colligan, MJ.Plain language about shiftwork. Cincinnati (OH): National Institute for Occupational Safety and Health; 1997.Google Scholar
30.Smith, L, Folkard, S, Poole, CJ.Increased injuries on night shift. Lancet 1994;344:1137–9.Google Scholar
31.Thomas, HA Jr.Eight- versus 12-hour shifts: implications for emergency physicians. Ann Emerg Med 1994;23:1096–100.Google Scholar
32.Kogi, K.Introduction to the problems of shift work. In: Folkard, S, Monk, T, editors. Hours of work. Chichester: Wiley; 1985.Google Scholar
33.Comperatore, CA, Krueger, BP.Circadian rhythm desynchronosis, jet lag, shift lag, and coping strategies. In: Scott, AJ, editor. Occupational medicine state of the art reviews. Vol 5. Shiftwork. Philadelphia: Hanley & Belfus; 1990.Google Scholar
34.Kuhn, WF, Wellman, A.The use of melatonin as a potential treatment of shiftwork sleep disorder. Acad Emerg Med 1998;5(8):852–3.Google Scholar
35.Harma, M.Ageing, physical fitness, shiftwork tolerance. Appl Ergon 1996;27(1):25.Google Scholar
36.Foret, J.Quality of sleep as a function of age and shiftwork. J Hum Ergol (Tokyo) 1982;11(suppl):149–54.Google Scholar
37.Gadbois, C.Women on night shift: interdependence of sleep and off-the-job activities. In: Reinberg, A, et al, editors. Night and shift work: biological and social aspects. Oxford: Pergamon Press; 1981.Google Scholar
38.Paley, MJ, Tepas, D.Fatigue and the shiftworker: firefighters working on a rotating shift schedule. Hum Factors 1994;36(2):269–84.Google Scholar
39.Winget, C, DeRoshia, CW, Holley, DC.Circadian rhythms in athletic performance. Med Sci Sports Ex 1985;17:498–516.Google Scholar
40.Folkard, S, Monk, T.Shiftwork and performance. Hum Factors 1979; 21:483–92.Google Scholar
41.Dinges, DF.Sleepiness and accidents: an overview. J Sleep Res 1995;4(suppl):S4–S14.CrossRefGoogle ScholarPubMed
42.Monk, T.Shiftworker performance. In: Occupational medicine: state of the art reviews. 1990;5(2):183–98.Google Scholar
43.Mitler, MM, Carskadon, MA, Czeisler, CA, Dement, WC, Dinges, DF, Graeber, RC.Catastrophes, sleep, and public policy: consensus report. Sleep 1988;11:100–9.Google Scholar
44.Monk, T, Folkard, S, editors. Shift work and performance. In: Hours of work. Chichester: Wiley; 1985.Google Scholar
45.Ehret, CF.New approaches to chronohygiene for the shift worker in the nuclear power industry. In: Reinberg, A, et al, editors. Night and shiftwork: biological and social aspects. Oxford: Pergamon Press; 1981.Google Scholar
46.National Transportation Safety Board. Grounding of the U.S. tankship Exxon Valdez on Bligh Reef, Prince William Sound near Valdez, AK on March 24, 1989. NTSB rep no MAR-90–04, NTIS rep no PB 90–916405.Google Scholar
47.Raymond, CA.Shifting work, sleep cycles on the way to becoming another public health issue. JAMA 1988;259(20): 2958–9.Google Scholar
48.Harris, W.Fatigue, circadian rhythm and truck accidents. In: Mackie, R, editor. Vigilance: theory, operational performance, and physiological correlates. New York: Plenum; 1977.Google Scholar
49.Steele, MT.The occupational risk of motor vehicle collisions for emergency medicine residents. Acad Emerg Med 1999;6: 1050–3.Google Scholar
50.Mills, ME, Arnold, B, Wood, CM.Core 12: a controlled study of the impact of 12 hour scheduling. Nursing Res 1983;32: 356–61.Google Scholar
51.Novak, RD, Auvil-Novak, SE.Focus group evaluation of night nurse shiftwork difficulties and coping strategies. Chronobiol Int 1996;13:457–63.Google Scholar
52.Parker, JB.The effects of fatigue on physician performance — an underestimated cause of physician impairment and increased patient risk. Can J Anaesth 1987;34(5):489–95.Google Scholar
53.Paget, NS, Lambert, TF, Sridhar, K.Factors affecting an anaesthetist’s work: some findings on vigilance and performance. Anaesth Intens Care 1981;9:359–65.Google Scholar
54.Smith-Coggins, R, Rosekind, MR, Buccino, KR, Dinges, D.F, Moser, RP.Rotating shiftwork schedules: Can we enhance physician adaptation to night shifts? Acad Emerg Med 1997;4:951–61.Google Scholar
55.Crosskerry, P, Sinclair, D.Emergency medicine: A practice prone to error? CJEM 2002;3(4):271–6.Google Scholar
56.Bohle, P, Tilley, J.The impact of night work on psychological well-being. Ergonomics 1989;32:1089–99.Google Scholar
57.Frese, M, Okonek, KA.Reasons to leave shiftwork and psychological and psychosomatic complaints of former shiftworkers. J Appl Psych 1984;69:509–14.Google Scholar
58.Costa, G.Gastrointestinal and neurotic disorders in textile shift workers. In: Reinberg, A, et al, editors. Night and shiftwork: biological and social aspects. Oxford: Pergamon Press; 1981.Google Scholar
59.Dunham, RB.Shiftwork: a review and theoretical analysis. Acad Mgmt Rev 1977;10:624–33.Google Scholar
60.Zun, L, et al. Longitudinal study of emergency physician wellness: initial impressions [abstract]. Ann Emerg Med 1990;19:496.Google Scholar
61.Folkard, S.Monk, TH.Hours of work: temporal factors in work scheduling. New York: John Wiley & Sons; 1984.Google Scholar
62.Walker, J.Social problems of shift work. In: Folkard, S, Monk, T, editors. Hours of work. Chichester: Wiley; 1985.Google Scholar
63.Mott, P.Shift work. Ann Arbor (MI): University of Michigan Press; 1965.Google Scholar
64.Margolick, D.The lonely world of night work. Fortune 1980; Dec.15:108–14.Google Scholar
65.Monk, TH, Folkard, S.Making shiftwork tolerable. London: Taylor and Francis; 1992.Google Scholar
66.Knutsson, A, Akerstedt, T, Jonsson, BG.Prevalence of risk factors for coronary artery disease among day and shift workers. Scand J Work Environ Health 1988;14:317–21.Google Scholar
67.Nurminen, T.Shift work and reproductive health. Scand J Environ Health 1998;24(suppl 3):28–34.Google ScholarPubMed
68.Bisanti, L, Olsen, J, Basso, O, Thonneau, P, Karmaus, W, and the European Study Group on Infertility and Subfecundity. Shift work and subfecundity: a European multicenter study. J Occup Environ Med 1996;38:352–8.Google Scholar
69.Adams, SL, Roxe, DM, Weiss, J, Zhang, F, Rosenthal, JE.Ambulatory blood pressure and Holter monitoring of emergency physicians before, during, and after a night shift. Acad Emerg Med 1998;5:871–7.Google Scholar
70.Knutsson, A, Akerstedt, T, Jonsson, BG, Orth-Gomer, K.Increased risk of ischaemic heart disease in shift workers. Lancet 1986;2:89–92.Google Scholar
71.Akerstedt, T, Knutsson, A, Alfredsson, L, Theorell, T.Shift work and cardiovascular disease. Scand J Work Environ Health 1984;10:409–14.Google Scholar
72.Kawachi, I, Colditz, GA, Stampfer, MJ, Willett, WC, Manson, JE, Speizer, FE, et al. Prospective study of shift work and risk of coronary heart disease in women. Circulation 1995;92:3178–82.Google Scholar
73.Czeisler, CA, Moore-Ede, MC, Coleman, RH.Rotating shift work schedules that disrupt sleep are improved by applying circadian principles. Science 1982;217:460–3.Google Scholar
74.Murphy, TJ.Fixed vs. rapid rotation shift work. J Occup Med 1979;21:318–24.Google Scholar
75.Turek, FW.Circadian principles and design of rotating shiftwork schedules. Am J Physiol 1986; 251:R636–8.Google Scholar
76.Barton, J, Folkard, S.Advancing versus delaying shift systems. Ergonomics 1993;36:59–64.Google Scholar
77.Veser, FH.The implementation of a forward-rotating template schedule and the effects upon physician wellness. Ann Emerg Med 1999;34(4 suppl 2):S69.Google Scholar
78.Krakow, B, Hauswald, M, Tandberg, D, Sklar, D.Floating nights: a 5-year experience with an innovative ED schedule. Am J Emerg Med 1994;12:517–20.Google Scholar
79.Reinberg, A, Andlauer, P, Guillet, P, Nicolai, A, Vieux, N, Laporte, A.Oral temperature, circadian rhythm amplitude, ageing, and tolerance to shiftwork. Ergonomics 1980; 23:55–64.CrossRefGoogle ScholarPubMed
80.Dirks, J.Adaptation to permanent night work: the number of consecutive work nights and motivated choice. Ergonomics 1993;36:29–36.Google Scholar
81.Barton, J, Spelten, E, Totterdell, P, Smith, L, Folkard, S.Is there an optimum number of night shifts? The relationship between sleep, health and well-being. Work Stress 1995;2:109–23.Google Scholar
82.American College of Emergency Physicians. Emergency physician shift work. Policy no. 400166. Texas: The College; 1994. Available: www.acep.org/1,4244,0.html (accessed 2002 Aug 19).Google Scholar
83.Monk, TH.Advantages and disadvantages of rapidly rotating shift schedules — a circadian viewpoint. Hum Factors 1986;28:553–7.Google Scholar
84.Knauth, P.The design of shift systems. Ergonomics 1993;36: 15–28.Google Scholar
85.Rutenfranz, J, Kanath, T.Hours of work and shift work. Ergonomics 1976;19:331–40.Google Scholar
86.Knauth, T, Rutenfranz, J.Development of criteria for the design of shiftwork systems. J Human Ergol (Tokyo) 1982;11(suppl):337–67.Google Scholar
87.Steele, MF, Ma, OJ, Watson, WA, Thomas, HA Jr.Emergency medicine residents’ shiftwork tolerance and preference. Acad Emerg Med 2000;7:670–3.Google Scholar
88.Steele, MT, Watson, WA.Emergency medicine residency faculty scheduling: current practice and recent changes. Ann Emerg Med 1995;25:321–4.Google Scholar
89.Rissman, BS.Shift work indicated as a possible health hazard. Hosp Empl Health 1991;10:69–72.Google Scholar
90.Price, CA.The 12 hour shift: Is it viable? Nurs Outlook 1984;32:193–6.Google Scholar
91.Palmer, J.8 and 12 hour shifts: comparing nurses’ behavior patterns. Nursing Mgmt 1991; 21:42–4.Google Scholar
92.Vik, A, MacKay, R.How does a 12 hour shift affect the patient care? J Nurs Admin 1982;Jan:11–4.Google Scholar
93.Todd, C, Robinson, G, Todd, C.The quality of nursing care on wards working 8 and 12 hour shifts: a repeated measure study using the monitor index of quality of care. Int J Nurs Stud 1989;26:359–68.Google Scholar
94.Knauth, P.Designing better shift systems. Appl Ergon 1996; 27(1):39.Google Scholar
95.Minors, DS, Waterhouse, JM.Stabilizing rhythms on irregular schedules. J Physiol (Lond) 1980; 298:31–2.Google Scholar
96.Webb, WB, Agnew, HW.Variables associated with split period sleep regimens. Aerospace Med 1971;45:701–4.Google Scholar
97.Dawson, D.Living with shiftwork. University of South Australia Centre for Sleep Research, 2000. Available: www.unisa.edu.au/sleep/main/tcsr_home.htmlGoogle Scholar
98.Czeisler, CA, Johnson, MP, Duffy, JF, Brown, EN, Ronda, JM, Kronauer, RE.Exposure to bright light and darkness to treat physiologic maladaption to night work. N Engl J Med 1990;322:1253–9.Google Scholar
99.Arendt, J.Melatonin, circadian rhythms, and sleep. N Engl J Med 2000;343(15):1114–6.Google Scholar
100.James, M, Tremea, MO, Jones, JS, Krohmer, JR.Can melatonin improve adaptation to night shift? J Emerg Med 1998;16:367–70.Google Scholar
101.Wright, SW, Lawrence, LM, Wrenn, KD, Haynes, ML, Welch, LW, Schlack, HM.Randomized clinical trial of melatonin after night-shift work: efficacy and neuropsychologic effects. Ann Emerg Med 1998;32(pt 1):334–40.Google Scholar
102.Jockovich, M, Cosentino, D, Cosentino, L, Wears, RL, Seaberg, DC.Effects of exogenous melatonin on mood and sleep efficiency in EM residents working night shifts. Acad Emerg Med 2000;7(8):955–8.Google Scholar
103.Jorgensen, KM, Witting, MD.Does exogenous melatonin improve day sleep or night alertness in emergency physicians working nights? Ann Emerg Med 1998;31:699–704.Google Scholar
104.Moline, ML.Effects of the “jet lag diet” on the adjustment to a phase advance. Proceedings of the 2nd Annual Meeting of the Society for Research on Biological Rhythms, White Plains (NY): 1990.Google Scholar
105.Ehret, CF.The Argonne Anti-Jet-Lag Diet. publ no 754–319. Washington (DC): US Dept of Energy; 1983.Google Scholar
106.Ehret, EF, Scanlon, LW.Overcoming jet lag. New York: Berkeley Publishing Group; 1983.Google Scholar
107.Kalimo, R, Tenkanen, L, Härmä, M, Poppius, E, Heinsalmi, P.Job stress and sleep disorders: findings from the Helsinki Heart Study. Stress Med 2000;16(2):65–75.3.0.CO;2-8>CrossRefGoogle Scholar