Emergency Physician Shift Work

Revised and approved by ACEP Board of Directors September 2003 and June 2010
Reaffirmed by the ACEP Board of Directors October 1998
Originally approved by the ACEP Board of Directors September 1994

As an adjunct to this policy, ACEP has prepared a Policy Resource Education Paper (PREP) titled, "Circadian Rhythms and Shift Work" 

The American College of Emergency Physicians believes that the best interests of patients are served when emergency physicians practice in a fair, equitable, and supportive environment.

The emergency physician's well-being is of fundamental importance to success and longevity in a career in emergency medicine. Well-being is adversely affected by
constantly rotating shifts. The effects of rotating shifts are cumulative, and represent one of the most important reasons physicians leave the specialty. Rotating shifts become more difficult as one ages. The College therefore endorses the following principles:

• Shifts should be scheduled, whenever possible, in a manner consistent with circadian principles. For most settings, scheduling isolated night shifts or relatively long sequences of night shifts is recommended. 
• Overly long shifts or inordinately long stretches of shifts on consecutive days should be avoided whenever possible. In most settings, shifts should last twelve hours or less. Schedulers should take into consideration the total number of hours worked by each practitioner and the intervals of time off between shifts. ACEP strongly recommends that practitioners have regularly scheduled periods of at least 24 hours off work.
• Rotating shifts in a clockwise manner (day to evening to night) is preferred. This applies even when there are intervening days off.
• Night shift workers' schedules must be designed carefully to provide for anchor sleep periods, and those workers' daytime responsibilities should be held to an absolute minimum. Groups should consider various incentives to compensate those working predominantly night shifts. 
• Schedules for emergency physicians should take into account factors such as ED volume, patient acuity levels, non-clinical responsibilities, and individual physician's age.
• A place to sleep before driving home after night shifts should be provided. 
  
   

References

1. Akerstedt T, Wright KP Jr. Sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4:257-271.
2. Barger LK, Cade BE, Ayas NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med. 2005;352(2):125-34.
3. Brown DL, Feskanich D, Sanchez BN, et al. Rotating night shift work and the risk of ischemic stroke. Am J Epidemiol. 2009;169(11):1370-1377.
4. Burch JB, Tom J, Zhai Y, et al. Shiftwork impacts and adaptation among health care workers. Occup Med (Lond). 2009;59(3):159-166.
5. Cydulka RK, Korte R. Career satisfaction in emergency medicine: The ABEM Longitudinal Study of Emergency Physicians. Ann Emerg Med. 2008;51(6):714-722.\
6. Folkard S. Shift work, safety and aging. Chronobiol Int 2008;25(2):183-198.
7. Hublin C, Partinen M, Koskenvuo K, et al. Shift-work and cardiovascular disease: a population-based 22-year follow-up study. Eur J Epidemiol. 2010;25(5):315-323.
8. Kuhn G. Circadian rhythm, shift work and emergency physicians. Ann Emerg Med. 2001;37:88-98.
9. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: Part 1, basic principles, shift work and jet lag sisorders. Sleep. 2007;30(11):1460-1483.
10. Ware JC, Risser MR, Manser T, et al. Medical resident driving simulator performance following a night on call. Behav Sleep Med. 2006;4(1):1-12.