{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:02:37Z","timestamp":1786417357451,"version":"build-2736575974"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,3,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVES:<\/jats:title>\n                  <jats:p>Extended-duration work rosters (EDWRs) with shifts of 24+ hours impair performance compared with rapid cycling work rosters (RCWRs) that limit shifts to 16 hours in postgraduate year (PGY) 1 resident-physicians. We examined the impact of a RCWR on PGY 2 and PGY 3 resident-physicians.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>Data from 294 resident-physicians were analyzed from a multicenter clinical trial of 6 US PICUs. Resident-physicians worked 4-week EDWRs with shifts of 24+ hours every third or fourth shift, or an RCWR in which most shifts were \u226416 consecutive hours. Participants completed a daily sleep and work log and the 10-minute Psychomotor Vigilance Task and Karolinska Sleepiness Scale 2 to 5 times per shift approximately once per week as operational demands allowed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Overall, the mean (\u00b1 SE) number of attentional failures was significantly higher (P =.01) on the EDWR (6.8 \u00b1 1.0) compared with RCWR (2.9 \u00b1 0.7). Reaction time and subjective alertness were also significantly higher, by \u223c18% and \u223c9%, respectively (both P &amp;lt;.0001). These differences were sustained across the 4-week rotation. Moreover, attentional failures were associated with resident-physician\u2013related serious medical errors (SMEs) (P =.04). Although a higher rate of SMEs was observed under the RCWR, after adjusting for workload, RCWR had a protective effect on the rate of SMEs (rate ratio 0.48 [95% confidence interval: 0.30\u20130.77]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Performance impairment due to EDWR is improved by limiting shift duration. These data and their correlation with SME rates highlight the impairment of neurobehavioral performance due to extended-duration shifts and have important implications for patient safety.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2020-009936","type":"journal-article","created":{"date-parts":[[2021,2,22]],"date-time":"2021-02-22T09:30:18Z","timestamp":1613986218000},"source":"Crossref","is-referenced-by-count":35,"title":["Extended Work Shifts and Neurobehavioral Performance in Resident-Physicians"],"prefix":"10.1542","volume":"147","author":[{"given":"Shadab A.","family":"Rahman","sequence":"first","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"},{"name":"Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason 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Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor S.","family":"O\u2019Brien","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie L.","family":"Stone","sequence":"additional","affiliation":[{"name":"California Pacific Medical Center Research Institute, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.K.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"},{"name":"Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;"},{"name":"Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth B.","family":"Klerman","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"},{"name":"Division of Sleep Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim","family":"Qadri","sequence":"additional","affiliation":[{"name":"Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women\u2019s Hospital, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr","given":"Kenneth P.","family":"Wright","sequence":"additional","affiliation":[{"name":"Sleep and Chronobiology Laboratory, Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann C.","family":"Halbower","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Hospital Colorado and School of Medicine, University of Colorado, Aurora, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey L.","family":"Segar","sequence":"additional","affiliation":[{"name":"University of Iowa Stead Family Children\u2019s Hospital, Iowa City, Iowa;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"McGuire","sequence":"additional","affiliation":[{"name":"Seattle Children\u2019s Hospital, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael V.","family":"Vitiello","sequence":"additional","affiliation":[{"name":"Departments of Psychiatry and Behavioral Sciences, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horacio O.","family":"de la Iglesia","sequence":"additional","affiliation":[{"name":"Biology, University of Washington, Seattle, Washington;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue E.","family":"Poynter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pearl L.","family":"Yu","sequence":"additional","affiliation":[{"name":"University of Virginia Children\u2019s Hospital, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy L.","family":"Sanderson","sequence":"additional","affiliation":[{"name":"Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis C.","family":"Zee","sequence":"additional","affiliation":[{"name":"Center for Circadian and 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