Clinical Activity During Night-shift: an Ecological Study

A convenient sample of internal medicine residents will be observed during their nightshift work in the wards of the department of internal medicine of a university hospital. The epidemiology of night calls and emergencies, including incidence, causes, management, and prognosis, will be assessed prospectively. The impact of nightshift work on sleep, stress, quality of life, regrets, and general well being of the residents observed will be measured through completion of validated questionnaires. Quality of handoff sessions will also be assessed.

Study Overview

• Status: Completed
• Conditions: Stress, Psychological; Sleep; Regret; Nightshift Work; Handoff Sessions

Detailed Description

Various medical problems of patients admitted to an internal medicine ward can worsen during the stay. Furthermore, new, unidentified problems can develop (complications, medication errors, delirium, acute anxiety or pain, etc). During evenings, nights and week-ends, emergent needs of hospitalized patients are usually cared for by physicians in-training, who are in charge of a large number of patients. Hence, physicians should have a wide range of medical knowledge and procedural skills and know how acute problems are dealt with in the unique environment of the healthcare institution. Training physicians should also be able to obtain information and counseling efficiently, either from clinical guidelines, senior supervisors, or specialists.

These requirements may represent a significant stress for training physicians and may have a major impact on their health, quality of life, and finally on the quality of inpatient care. Nightshift work may lead later to a high burden of regrets among caregivers.

Better knowledge of training needs, organization features, coping strategies, and regrets associated with nightshift duty are important to prepare training physicians to that demanding and necessary task. Understanding of the epidemiology of night-shift ward emergencies could provide guidance concerning the required level of staffing and training of the responding medical team.

Furthermore, efficient transmission of information between day and night staff (so-called handoffs) is a difficult yet important part of care. Systematic observation of handoff sessions between physicians before and after nightshifts may enhance previous knowledge on key components of these topics.

The investigators will evaluate the incidence causes, and prognosis of night-shift emergencies in internal medicine wards by direct observation of the nightshift work of a convenient sample of internal medicine residents. By the means of before-and-after shift completion of various validated questionnaires, the investigators will explore quantitatively and qualitatively the physiological and psychological impact on nightshift work for physicians in training.

The planned study will also provide qualitative and quantitative data concerning handoffs session, and the repercussions on night shift emergencies management.

• Study Type: Observational
• Enrollment (Actual): 41

Contacts and Locations

Study Locations

• Switzerland
  • Geneva, Switzerland, 1205
    • Geneva University Hospitals

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 22 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

see above

Description

Inclusion Criteria:

• resident in training in the internal medicine department, involved in one or more nightshift during the study

Exclusion Criteria:

• unwilling to participate

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of nightshift interventions		12 hours
% of patients with nightshift interventions of different intensity	Rated on an ad-hoc scale (from "phone intervention only" to "active resuscitation")	12 hours
% of patients with different causes of nightshift interventions	Rated on an ad-hoc scale listing the different causes (e.g. acute confusion; chest pain, etc)	12 hours
Incidence of selected outcomes of nightshift intervention	Rated on an ad-hoc scale (from "death" to "problem resolves without further intervention"	24 hours
Incidence of specific interventions during nightshift	Rated on an ad-hoc list, from "Provision of CPR or intubation" to "Prescription of any new drug"	12 hours
Incidence of predictable nightshift emergencies	Rated on an ad-hoc scale, from "Unexpected" to "Expected"	12 hours
Incidence of preventable nightshift emergencies	Rated on an ad-hoc scale, from "Unpreventable" to "Very likely preventable"	12 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
incidence of sleep problems in nightshift residents		30 days
severity of sleep problems in nightshift residents	measured with the insomnia severity index questionnaire, ISI	30 days
incidence of stress symptoms in nightshift residents		30 days
severity of stress symptoms in nightshift residents	Measured with an ad hoc scale (From "no stress at all" to "intense stress most of the time")	30 days
incidence of regrets in nightshift residents		30 days
severity of regrets in nightshift residents	Measured with the regret intensity questionnaire(RIS-10)	30 days
incidence of burnout symptoms in nightshift residents		30 days
severity of burnout symptoms in nightshift residents	Measured with the Copenhagen Burnout Inventory, CBI	30 days

Collaborators and Investigators

• Sponsor: University Hospital, Geneva
• Investigators: Principal Investigator: Pauline DARBELLAY FARHOUMAND, MD, Geneva University Hospitals, General Internal Medicine Department

Study record dates

Study Major Dates

• Study Start (Actual): October 3, 2019
• Primary Completion (Actual): April 21, 2020
• Study Completion (Actual): April 21, 2020

Study Registration Dates

• First Submitted: October 3, 2019
• First Submitted That Met QC Criteria: October 9, 2019
• First Posted (Actual): October 10, 2019

Study Record Updates

• Last Update Posted (Actual): September 2, 2020
• Last Update Submitted That Met QC Criteria: August 31, 2020
• Last Verified: August 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Behavioral Symptoms; Stress, Psychological
• Other Study ID Numbers: SMIG_001

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No