Strategies to manage residents’ fatigue must balance patient safety, resident education and resident wellbeing. The trade-offs among these are not fully understood. The Intensive Care Unit Resident Scheduling -InCURS- trial is a Canadian cluster-RCT to provide much needed evidence to inform resident scheduling practice and policy.
Evaluating the impact of ICU resident overnight duty schedules of 16 and 24 hours duration on patient mortality, healthcare associated harm, resident education and resident wellbeing.
Design: A cluster-randomized crossover trial will compare 16h vs. 24h overnight schedules for residents rotating to ICU.
Eligible ICUs: care for adult patients, and have rotating residents who perform overnight in-house duty.
Intervention 16h and 24h overnight schedules will both be applied for 52 weeks at each site. Schedule crossover order will be randomly allocated (1:1 ratio). All in-house residents will participate in the schedule.
Primary outcome: Hospital mortality to 90 days after index ICU admission.
Secondary outcome: Adverse events, resident cognitive reasoning and resident emotional exhaustion (burnout).
InCURS is anticipated to include 1,440 rotating residents, 34,000 patients and the perspectives of over 4,000 ICU healthcare professionals. It will also enable other important secondary questions to be addressed.
