A New England Journal of Medicine study published in 2005 found that “extended-duration work shifts…pose safety hazards for interns.” The study noted that extended shifts increased a resident’s risk of being involved in a car accident during the commute home from the hospital by more than 16%. The study further noted “implications for medical residency programs, which routinely schedule physicians to work more than 24 consecutive hours.”
Several years ago, the Accreditation Council for Graduate Medical Education (ACGME) issued new guidance for residency programs to mitigate the risks associated with sleep deprivation. The guidelines call for restricted duty hours and encourage education about the effects of sleeplessness. But in practice, the measures hospitals take to address sleeplessness — on-call rooms — have major drawbacks, both from the perspective of the residents as well as for the hospitals.
On-call rooms typically comprise a small room with a single bed, sometimes equipped with a desk and a chair. The number of on-call rooms available usually depends on the size of the facility, but they are often grouped together in a section of the hospital. The rooms are typically locked to prevent patients and unauthorized staff from accessing the space, with all residents provided with a key or code.
From the residents’ perspective, this approach isn’t optimal since there is no way to determine if a room is occupied or not, and sleeping residents are frequently disturbed by colleagues seeking an empty room. On-call rooms are not necessarily placed near the units residents are covering, so proximity to patients can be an issue, especially in big facilities. From the hospitals’ perspective, the large footprint of the on-call rooms is a major cost, as are the janitorial services necessary to keep the rooms ready for residents.
There’s an alternative to traditional on-call rooms: napping facilities. Short-rest solutions can come in a variety of forms, featuring equipment such as high-tech napping pods, massage chairs and zero-gravity recliners. Short-rest facilities are already in use at many leading hospitals, universities and corporations, particularly high-tech companies that put a premium on employee creativity. These organizations adopted short-rest facilities in response to research that shows napping improves alertness and productivity.
But the benefits of napping aren’t confined to Silicon Valley: Napping studies have also been conducted in hospital settings to gauge the effect on physician performance. The Association of American Medical Colleges published a study in Academic Medicine entitled: “The Effects of a Mid-Day Nap on the Neurocognitive Performance of First-Year Medical Residents: A Controlled Interventional Pilot Study.” The study was designed to test the effect of a mid-day nap on residents’ cognitive functioning and alertness.
The results were impressive: a brief mid-day nap improved residents’ cognitive functioning and alertness considerably. The study also found that residents who napped “experienced fewer attention failures during their work later in the day,” and it also noted that residents who napped “demonstrated faster reaction time and made fewer errors of omission and commission.” The implications for performance of clinical duties are clear.
Hospitals obviously have a stake in clinician performance improvement, but beyond those immediate benefits, deployment of napping facilities can provide other positive results for healthcare organizations. Since the equipment has a smaller footprint and doesn’t require maintenance like a traditional on-call room, it can be much less expensive to operate, and the lower space requirement can enable hospitals to locate napping facilities closer to patient treatment areas so physicians can respond more quickly.
Another feature that benefits both the hospital and the physician is the inclusion of an electronic device that can indicate when napping facilities are occupied, eliminating scenarios where physicians accidentally wake up sleeping colleagues while trying to find an unoccupied on-call room. The devices can also gather data on room usage. This utilization information can help hospital decision-makers gauge current demand for napping facilities and follow trends to anticipate the need for more or fewer facilities.
Sleep-deprived residents make mistakes and are more prone to accidents, which is why residency programs’ governing bodies issued new guidance mandating more frequent periods of rest. But the traditional approach to providing onsite rest areas, on-call rooms, are often expensive to maintain, inconveniently located and difficult to use due to frequent interruptions. Research shows napping facilities can be a great alternative — and patients, residents and hospitals alike can benefit from a new approach to an old problem.
Christopher Lindholst is CEO of Restworks, a company that offers a comprehensive line of workplace napping solutions. A pioneer in corporate fatigue management solutions, Christopher has built a client base and established partnerships on four continents. Christopher is a member of the National Sleep Foundation’s Sleep Technology Council and a frequent speaker at corporations and conferences, where he talks about implementing sleep into corporate wellbeing programs.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
