Effects of home call on obstetrics and gynecology resident sleep patterns




Objective


Impaired physician performance from sleep deprivation has been linked to serious medical errors. In 2003, resident work rules were enacted to limit hospital work hours with the goal of improved patient safety. Since then, resident in-house call has decreased and home call has increased, despite little understanding of the impact of home call on sleep disruption and patient care. We evaluated home-call sleep patterns in an obstetrics and gynecology residency program.




Study Design


Obstetrics and gynecology residents (N = 14) were enrolled in a crossover study. On each of 3 separate weekends of home call, no call, or in-house call the resident wore an actigraph sleep monitor (Actiwatch Model AW64, Minimitter, Sun River, OR) and completed a sleep log (self-reported hours slept, sleep satisfaction, sleep quality, and awakening alertness). The daily sleep logs and actigraphy data for the 3 weekend types were compared using paired t tests (primary comparison groups home call vs no call). The study was powered to detect a difference of at least 0.66 hours per night between groups in total actigraphy-recorded hours slept each weekend.




Study Design


Obstetrics and gynecology residents (N = 14) were enrolled in a crossover study. On each of 3 separate weekends of home call, no call, or in-house call the resident wore an actigraph sleep monitor (Actiwatch Model AW64, Minimitter, Sun River, OR) and completed a sleep log (self-reported hours slept, sleep satisfaction, sleep quality, and awakening alertness). The daily sleep logs and actigraphy data for the 3 weekend types were compared using paired t tests (primary comparison groups home call vs no call). The study was powered to detect a difference of at least 0.66 hours per night between groups in total actigraphy-recorded hours slept each weekend.




Results


Among participants, 66.7% were <30 years old, 66.7% were female, 26.7% had children, and 46.7% had pets. None reported current tobacco or daily alcohol use. Residents generally believed they made sound decisions while taking home call, although reported it as stressful, exhausting, and disruptive to life outside work; 20% reported falling asleep in clinic or teaching sessions and 13% while driving following home call. Estimated average nightly sleep duration recorded by Actiwatch over an entire weekend was: 6.5 (±0.6) hours on home call, 7.3 (±0.4) hours on no call, and 5.0 (±0.6) hours on in-house call; findings were significantly different between home call and weekends off (actigraphy, P < .001, self-reported sleep, P = .02). Self-reported sleep satisfaction ( P = .004), sleep quality ( P = .002), and alertness ( P = .001) were diminished during home-call weekends compared with no-call weekends ( Figure ).




Figure


Resident sleep duration and quality

A , Objective and subjective report of sleep duration in hours per night (±SE) averaged over 3 nights on y axis, by type of weekend call (in-house, home, and no call) on x axis. Both objective and subjective sleep duration while on home call differed from no call ( P < .001 and .02, respectively). There was no significant difference in hours slept between home call and in-house call by sleep logs ( P = .12), but Actiwatch data indicated greater sleep duration on home call compared with in-house call ( P < .001). B , Sleep satisfaction on Likert scale (1 = very unsatisfied to 5 = very satisfied) on right y axis by type of weekend call (in-house, home, and no call) on x axis. Sleep quality from single-item Pittsburgh Sleep Quality Index score on left y axis by type of weekend call (in-house, home, and no call) on x axis. Alertness on awakening (1 = very drowsy, 2 = moderately drowsy, 3 = slightly drowsy, 4 = clear headed, 5 = alert, 6 = very alert) on left y axis by type of weekend call (in-house, home, and no call) on x axis. Home call differed from no call on all sleep quality measures ( P < .004). There were no differences between home call and in-house call for sleep satisfaction ( P = .35) and sleep quality ( P = .1), but alertness on awakening was lower for in-house call ( P = .02).

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May 4, 2017 | Posted by in GYNECOLOGY | Comments Off on Effects of home call on obstetrics and gynecology resident sleep patterns

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