The European working time directive was implemented for doctors in training in the UK NHS and elsewhere in Europe in August 2004. This represented a change from on−call cover to working in shifts. The reason for this was to improve doctors well being and effectiveness at work. Available research evidence indicates that doctors working shorter periods of time are less likely to make medical errors through tiredness and are less likely to have road accidents on the way home after work. Currently, junior doctors are restricted to working 56 hours a week.

In 2009 the legal working time drops to 48 hours per week. The UK Multidisciplinary Working Group has suggested an ideal rota to minimise errors. There is a need to evaluate the impact on doctors effectiveness and well being, patient safety, financial costs and organisational issues of this rota. This study will be important in gaining information about the impact of the changes before they are implemented.

Aim of Research:

To evaluate the impact of a change in junior doctors working hours from 56 to 48 hours/week so that information could be available before the changes were introduced in 2009.

University Hospitals Coventry & Warwickshire (UHCW) NHS Trust in Coventry allowed the pilot study to be carried out over a 6-months period (Feb-Jul 2007) on the Acute Medical Rota in that Trust. This large progressive NHS trust was been chosen for the complexity of the rota systems which involve many different medical sub-specialities. This enabled us to test the effects of change in a highly complex system – one that has had to make several ‘real-life’ adaptations in order to implement the desired intervention.

We used methodologies that have been previously used extensively in the study of work hours, sleep and fatigue in medical residents and police officers. Following completion of data collection, we compared these parameters in doctors working on the traditional versus the intervention schedule. Throughout the study rotations, subjects wore an activity monitoring device and completed a daily sleep and work hours log. Alertness, mood and general well-being will also be assessed.

Publications

• Cappuccio FP & Lockley SW. Safety and the flying doctor. Br Med J 2008; 336: 218
• Cappuccio FP, Lockley SW & Landrigan CP. EWTD is to improve health and safety of patients and doctors. Br Med J 2008;337:a3080 
• Cappuccio FP, Bakewell A, Taggart FM, Ward G, Ji C, Sullivan JP, Edmunds M, Pounder R, Landrigan CP, Lockley SW & Peile E on behalf of the Warwick EWTD Working Group. Implementing a 48h EWTD-compliant rota for junior doctors in the UK does not compromise patients' safety: assessor-blind pilot comparison. Q J Med 2009; 102: 271-82
• Cappuccio FP, Lockley SW, Landrigan CP. Cappuccio response to correspondence. Q J Med 2009;102:363-4
• Cappuccio FP. ‘Hospital at Night’ improves outcomes: does the evidence support opinions? Q J Med 2009;102:583-4
• Cappuccio FP & Miller MA. Chapter 18: European Working Time Directive and medical errors. In: Sleep, Health & Society: from aetiology to public health. FP Cappuccio, MA Miller, SW Lockley eds. Oxford University Press, 2010; pp. 397-411

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