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Tracy A. Lieu, MD; Christopher B. Forrest, MD; Nathan J. Blum, MD; David Cornfeld, MD; Richard A. Polin, MD

Am J Dis Child. 1992;146(3):307-310.

Abstract
• Night-float systems have recently been proposed as a way to reduce resident stress resulting from irregular sleep patterns. We prospectively evaluated the effects of a night-float system in which designated residents relieved on-call senior residents and interns of routine admissions of patients in medically stable condition during the late-night period (11 PM to 7 AM). Senior residents (3.7 vs 2.4 hours) and interns (3.7 vs 3.2 hours) reported sleeping more under the night-float system than under the traditional system. The night-float system did not affect residents' overall ratings of call nights. Educators who reviewed medical records agreed with residents' decisions about patients' appropriateness for admission using the night-float system in 95 (81 %) of 117 cases. When educators disagreed with residents, the most common reasons were the patient's potential educational value or medical instability. The night-float system did not affect interns' ratings of the educational value of late-night admissions or parents' ratings of satisfaction with medical care. We conclude that the night-float system can increase resident sleep with little cost to parent satisfaction, but standards for selective use may be needed to avoid compromising patient care and resident education.

(AJDC. 1992;146:307-310)

Author Affiliations
From the Divisions of General Pediatrics (Drs Lieu, Forrest, Blum, and Cornfeld) and Neonatology (Dr Polin), Department of Pediatrics, University of Pennsylvania, Philadelphia, and the Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco (Dr Lieu).

Footnotes
Accepted for publication September 23, 1991.

Presented in part at the annual meeting of the Society for Pediatric Research, New Orleans, La, April 29,1991.

Reprint requests to the Robert Wood Johnson Clinical Scholars Program, University of California, San Francisco, Box 0903, C-126, San Francisco, CA 94143-0903 (Dr Lieu).

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