Intended for healthcare professionals


Plans to update European working time legislation in disarray

BMJ 2008; 337 doi: (Published 19 December 2008) Cite this as: BMJ 2008;337:a3080

EWTD is to improve health and safety of patients and doctors

A number of articles in the lay press and this in the BMJ highlight
possible consequences of limiting work hours for junior doctors to 48
h/week from August 2009 as required by the European Working Time
Directive. While the concerns raised by the British Medical Association
will be important to address as the Directive is implemented, it is
essential that the reasons why the Directive was implemented in the first
place be kept firmly in mind - to improve patient and staff safety. The
difference between 56 and 48h/week may appear small when averaged over 6
months (as is the current standard) but the difference in any given week
can be considerable, as doctors still legally work nearly 80h a week in
some weeks. Such extreme work hours have been repeatedly demonstrated to
endanger both patients and doctors. The argument that the 48h limit will
have a negative impact on both patients and junior doctors performance or
education is not supported by any objective data. On the contrary, several
US studies provide robust evidence to show that doctors working long hours
make mistakes that harm patients and themselves and that reducing work
hours and shift duration improves patient safety. In the UK, recent data
from our own studies show that implementation of a 48h EWTD-compliant
rota, if designed appropriately and paired with efforts to improve sleep
hygiene, is associated with as much as a 33% reduction in medical error
rates as compared to current working practices within a 56-h/week limit.
Limiting consecutive night shifts to no more than three, limiting shift
duration to 12h, and abolishing rapid day-to-night ‘slam-shifts are all
measures that reduce acute and chronic partial sleep deprivation,
facilitate adaptation of circadian rhythms and enhance recovery sleep,
thereby reducing sleepiness and improving doctors performance and patient

It is unquestionably the case that more doctors and health-care
providers are needed to implement a 48h work week optimally and we support
the plea to the Government for ring-fencing allocated budgets for
provision of more staff. Changes in educational models will also be needed
to train junior doctors most effectively under this newer system. Given
the high negative impact of long hours on doctors ability to perform
safely, however, we cannot ignore an opportunity that has the potential to
improve patient safety and junior doctors working conditions. If
implemented properly, the EWTD Directive provides that opportunity and
should be embraced.

Competing interests:
None declared

Competing interests: No competing interests

31 December 2008
Francesco P Cappuccio
Steven W Lockley, Christopher P Landrigan (Harvard Medical School, Boston)
University of Warwick Medical School, Coventry, CV2 2DX