The effect of switching from 24-hour on-call shifts for psychiatry residents to 10-14-hour shifts on quality of care and workflow

The effect of switching from 24-hour on-call shifts for psychiatry residents to 10-14-hour shifts on quality of care and workflow | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The effect of switching from 24-hour on-call shifts for psychiatry residents to 10-14-hour shifts on quality of care and workflow Samah H. Alkhawashki, Meteb H Alenazi, Faysal Alahmari, Ali A. Alshehri, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8206621/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Extended on-call duty hours for residents are associated with burnout and potential risks to patient care. This quality improvement (QI) project evaluated the effect of reducing psychiatry residents’ on-call shifts from 24 hours to 10–14 hours on clinical workflow efficiency at King Saud University Medical City (KSUMC). Methods A retrospective cohort design evaluated the effects of the shift change among psychiatry residents in January (24-hour shifts), February (12-hour shifts), and March (10–14-hour shifts). Residents documented time metrics for 116 consultations. Key outcomes were time from consultation acceptance to patient viewing and the time from consultation acceptance to plan finalization, reported in median minutes and interquartile range (IQR). The Kruskal-Wallis test was used to analyze differences between months. Results A total of 116 consultations were received. The majority (67%) resulted in patient discharge. While admitted patients showed no significant difference, the time from consultation acceptance to plan finalization for discharged patients showed a statistically significant improvement across the three months (P = 0.007). The median time for this metric was 145 minutes in January, 150 minutes in February, and the shortest was 118 minutes in March. Residents gave positive qualitative feedback, noting reduced fatigue. Conclusion Reducing on-call shift duration was feasible and improved workflow efficiency for discharge-related cases, suggesting that well-rested residents are better able to handle cognitively demanding, time-sensitive tasks. The findings support local and global efforts to prioritize physician well-being without compromising care quality and demonstrate the positive potential of duty-hour reform. Quality improvement on-call psychiatry residents medical training shift work Figures Figure 1 Figure 2 Background The well-being of physicians, particularly those in training such as residents, is a critical aspect of healthcare that directly impacts the quality of patient care. Long shifts and on-call duties are intrinsic to medical training but pose significant challenges to physician well-being. Hence, we examined the effects of extended work hours on the mental and physical health of medical trainees, with a focus on improving healthcare quality. Long shifts have been linked to affecting mental health among physicians. Studies show that extended duty hours lead to burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment ( 1 ). If left unattended, burnout can escalate to substance use, depression, and, in severe cases, suicide ( 2 ). Nearly half of all physicians experience burnout, with residents and early-career physicians being particularly vulnerable ( 3 ). The physical toll of long shifts on physicians is equally concerning. Prolonged hours can lead to chronic sleep deprivation, and it has been noted that sleep-deprived individuals exhibit reduced attention, slower reaction times, and impaired memory, which are critical faculties for physicians ( 4 ). These impairments can lead to increased medical errors, adversely affecting patient safety and the quality of care. A study demonstrated that interns working traditional schedules with extended shifts made 36% more serious medical errors compared to those with shorter shifts ( 5 ). Psychiatry trainees bear additional and distinct burdens. These include the continual efforts required to build therapeutic connections with patients, the perceived stigma associated with the field, personal safety concerns due to potential violence from patients, and the emotional weight of patient suicides ( 6 ). Alkhamees et al. found that burnout symptoms were found in 27.3% of psychiatric residents, and another 27.3% had depressive symptoms, while 16.5% experienced both, in a study that took place in Saudi Arabia during the COVID-19 outbreak ( 7 ). In Saudi Arabia, a study focusing on medical residents at King Fahd University Hospital revealed a high prevalence of sleep deprivation, which was significantly associated with depressive symptoms, advocating for the revision of regulations concerning working hours and night shifts for medical residents ( 8 ). Additionally, a study examining pediatric residents' perceptions of the 24-hour on-call system found that prolonged on-call duties negatively affected their well-being, education, and patient safety, and that the majority of residents preferred not to continue with the 24-hour on-call system ( 9 ). Training programs should consider exploring reforms to resident duty hours and assessing alternative on-call models to enhance resident well-being and training, as well as improve patient care. The U.S. medical residency training system began at Johns Hopkins in 1889, with residents living in hospitals and working extremely long hours; by the mid-1900s, residents routinely worked over 100 hours per week. Efforts to reform these conditions began with a 1975 strike in New York City and accelerated after the 1984 Libby Zion case, culminating in the Bell Commission's 1987 recommendation of an 80-hour workweek. The ACGME gradually implemented these limits across specialties, culminating in nationwide duty-hour regulations in 2003 and further restricting intern shifts to 16 hours in 2011, reflecting a century-long evolution toward safer and more humane working conditions for residents ( 10 ). In 2011, the Accreditation Council for Graduate Medical Education (ACGME) Task Force implemented new recommendations on duty hours, with a maximum period of duty, limiting continuous duty to 24 hours with an additional four hours for transition and handover activities for intermediate and senior residents, and not to exceed 16 hours for junior residents. This update marks a significant departure from the 2003 recommendations, which allowed for up to 30 hours of continuous duty. This shift reflects a growing recognition within the medical community of the importance of addressing physician well-being and ensuring adequate rest periods to optimize patient care quality ( 11 ). The Saudi Commission for Health Specialties has established specific guidelines for duty-hour regulations within the psychiatry program, while adhering to longstanding traditions. These guidelines specify that on-call duties must align with the hospital's designated duty hours policies and procedures. On-call responsibilities are scheduled no more frequently than every third night, averaged over four weeks. The duration of on-call hospital duties is limited to 24 consecutive hours. Following this period, residents may continue for up to six additional hours to engage in educational activities, transfer patient care, manage outpatient clinics, and ensure continuity of medical care. Importantly, no new patients will be assigned after 24 hours of continuous duty ( 12 ). Addressing systemic issues contributing to physician burnout requires ongoing attention from policymakers. Future research should focus on the long-term impacts of duty hour reforms and innovative well-being strategies. Investing in programs that promote work-life balance is essential for sustainable healthcare systems that prioritize both patient care and physician well-being. Tailored interventions are crucial for residency and psychiatry trainees, who are particularly affected by long shifts. Through quality improvement initiatives and policy adjustments, physician well-being can be improved, leading to better patient care outcomes. Ongoing research and innovation are key to developing sustainable solutions for medical professionals' health and effectiveness. Methods Study Design, Participants, and Setting This study utilized a retrospective cohort design to evaluate the effect of switching from 24-hour on-call shifts to 10 to 14-hour shifts on quality of care and workflow. This study was conducted within the Psychiatry Residency Program at King Saud University Medical City in Riyadh, Saudi Arabia. It targeted psychiatry residents in postgraduate years 1 through 4 who rotated between January and March 2024. Inclusion criteria involved on-call reports from residents on duty during this period, with no exclusions. No identifying data was collected, and informed consent was deemed unnecessary. Procedure and Data Collection Data were collected using Google Sheets, developed and overseen by the chief resident, and were reviewed by the training committee (Appendix 1). The Google Sheets link was distributed to all on-call residents, who were required to document specific details for each ER consultation, including the time of accepting the consultation, the time of seeing the patient, the time of finalizing the management plan, and the disposition. The process was done over three months in 2024: January, February, and March. During this time, on-call shifts were adjusted each month: 24 hours in January, 12 hours in February, and 10 to 14 hours in March. By the end of each shift, feedback on the shift changes was collected from all residents using a Google Forms questionnaire. This information was initially intended to serve as evidence to support the shift duration change, which was part of an internal quality improvement project. The positive impact of the shift duration change was noticeable, prompting the research team to obtain Institutional Review Board approval to access the data for publication, as the 10 to 14-hour model remains the implemented model at our institution. Statistical Analysis Data analyses were performed using SPSS version 23. Data on time in this study were presented in minutes rather than hours and summarized using the median and interquartile range. The difference between months was assessed using the Kruskal-Wallis test for nonparametric numeric variables. Results A total of 116 consultations were received across three months: January (n=58, 50%), February (n=28, 24%), and March (n=30, 26%). Most of these shifts ended with discharge (n=78, 67%), and the third with admission (n=36, 31%). Overall, the median time from accepting the consultation to seeing the patient was 22 minutes (IQR 10-45), and the median time from finalizing the plan to accepting the consultation was 128.5 minutes (IQR 97-180). The median time by month and status is reported in Table 1, and visualized in Figures 1 and 2. Using ANOVA, we examined the time difference between months in each status. Regarding admission, there is no difference in time between accepting the consultation and seeing the patient over months (P value = 0.237). Additionally, there is no difference in time between finalizing the plan and accepting the consultation across months (P-value = 0.913). Regarding discharge, there is no difference in time between accepting the consultation and seeing the patient across months (P value = 0.445). However, there is a difference in time between finalizing the plan and accepting the consultation across months, P-value (0.007). The longest time was in February, followed by January, then March. See Table 2. Table 1: Median and IQR of time in each month Time between accepting the consultation and seeing the patient Time between finalizing the plan and accepting the consultation Month Status count median IQR median IQR January Admission 21 25 13 - 40 127 103 - 180 Discharge 36 26.5 10 - 50 145 91.5 - 192 Ehalah,Absconded 1 22 22 - 22 122 122 - 122 February Admission 4 12 10 - 100.5 129 50 - 221.5 Discharge 23 18 18 - 64 150 125 - 200 Ehalah,Absconded 1 17 17 - 17 107 107 - 107 March Admission 11 12 8 - 25 130 85 - 187 Discharge 19 21 14 - 40 118 91 - 125 Table 2: Mean difference of time in minutes across months for admission decision and discharge decision. N Mean Std. Deviation Sig. Admission Time between accepting the consultation and seeing the patient January 21 29.43 19.43 0.237 February 4 55.25 87.85 March 11 21.64 23.94 Time between finalizing the plan and accepting the consultation January 21 149.00 82.04 0.913 February 4 135.75 108.01 March 11 159.64 126.64 Discharge Time between accepting the consultation and seeing the patient January 36 35.39 29.96 0.445 February 23 46.87 67.48 March 19 30.53 24.29 Time between finalizing the plan and accepting the consultation January 36 147.22 65.52 0.007 February 23 162.74 52.31 March 19 108.68 27.14 Discussion This quality improvement (QI) project evaluated the impact of reducing psychiatry residents’ on-call shift lengths from 24 hours to 10–14 hours at King Saud University Medical City (KSUMC). Over three months, workflow data demonstrated a significant improvement in the time from consultation acceptance to plan finalization for discharged patients (p = 0.007), while no significant differences were observed for admissions. Qualitative feedback from residents highlighted reduced fatigue and better focus during shorter shifts. However, some challenges were noted during the month of Ramadan, when altered sleep–wake schedules affected alertness and workflow. Consultants emphasized the need for clearer handover policies and standardized end-of-shift responsibilities. The improvement in discharge-related workflow efficiency likely reflects reduced cognitive fatigue, enabling residents to make decisions more effectively and maintain concentration throughout the shift. Shorter shifts appeared to benefit cases involving patient discharge more than those requiring admission. Admission workflows typically involve more complex clinical and administrative processes, multidisciplinary coordination, and bed availability issues, which may limit the influence of duty-hour reforms on these timelines. One possible explanation is that discharged cases are more sensitive to residents’ alertness and emotional energy. Managing these cases often demands nuanced communication, empathy, and clinical judgment, all of which depend heavily on cognitive freshness. By contrast, “workflow-complex” tasks such as admissions may be constrained by systemic or procedural factors rather than by individual cognitive performance. Thus, while intrinsically complex cases (e.g., severe psychiatric admissions) naturally require time, the efficiency gains observed in discharge cases suggest that well-rested residents are better able to process, decide, and finalize management plans. Overall, the findings support the hypothesis that the impact of duty-hour reforms may depend on the nature of the clinical task—with cognitively demanding but time-sensitive decisions benefiting most from reduced fatigue, while system-driven processes remain less affected. These findings are consistent with international evidence linking reduced duty hours to improved cognitive performance, decreased burnout, and maintained or enhanced quality of care. Landrigan et al. (2004) demonstrated a 36% reduction in serious medical errors after limiting intern work hours, highlighting the safety benefits of mitigating fatigue ( 5 ). Although the present study did not measure adverse events, the improvement in workflow efficiency may reflect similar underlying mechanisms of enhanced alertness and decision quality. Saudi-based studies have also shown that prolonged on-call duties negatively affect resident well-being and patient safety. For instance, Al-Maddah et al. (2015) and Alsohime (2019) reported that extended shifts were associated with sleep deprivation, depressive symptoms, and reduced educational satisfaction. Locally, burnout prevalence among psychiatry residents has been particularly high, emphasizing the need for structural interventions that support physician wellness ( 8 , 9 ). Unlike many cross-sectional studies in the region, this project used a longitudinal, intervention-based approach, assessing operational metrics before and after implementation. It therefore contributes practical, context-specific evidence for duty-hour reform in Saudi psychiatry training programs. The progressive improvement in discharge-related efficiency across months suggests early adaptation to the new schedule. For sustainability, formalizing handover procedures, establishing precise referral cutoffs near shift end, and defining structured post-call relief protocols will be essential. Consultant feedback emphasized that consistent handover communication and shared expectations between residents and supervisors are critical for maintaining continuity of care. The number of residents available to staff multiple shorter shifts may influence scalability. Departments with smaller cohorts may face logistical challenges in splitting 24-hour coverage into multiple shorter rotations. Institutional support in workforce planning, duty scheduling, and resource allocation will therefore determine long-term success. Future research should evaluate the impact of shortened shifts over longer periods, ideally extending beyond Ramadan to minimize seasonal variation. Studies should also incorporate validated instruments to assess resident-level outcomes (e.g., burnout, sleep quality, psychological well-being), patient-level outcomes (e.g., satisfaction, adverse events, treatment adherence), and system-level outcomes (e.g., consultant satisfaction, teaching quality, interdepartmental response times). Structured surveys and focus groups could provide deeper insights into the perceived benefits and challenges of the new model. Additionally, implementing standardized handover protocols and clarifying consultation responsibilities at shift changes will strengthen workflow consistency. Including patient safety metrics and qualitative analyses of decision quality will further enrich the understanding of the broader implications of duty-hour reform. Limitations Several limitations should be considered when interpreting these findings. First, the evaluation period was relatively brief, and it coincided with Ramadan (March 2024), which may have influenced residents’ sleep patterns, energy levels, and overall performance. Second, the absence of a control group limits the ability to establish causality for the observed improvements. Feedback was obtained through informal surveys rather than validated instruments, and no standardized tools were used to assess burnout, sleep quality, or well-being. In addition, outcome measures were confined to time-based metrics; indicators of patient safety and quality of care were not examined. The study sample was heterogeneous, including residents with varying employment statuses, training levels, and prior experiences, which may have affected performance outcomes. Finally, concerns related to handover clarity, referral cutoffs, and post-call duties were noted but not systematically measured. These limitations underscore the need for a more comprehensive and methodologically rigorous evaluation to fully capture the impact of duty-hour reform on both resident performance and patient care outcomes. Conclusion Reducing psychiatry residents’ on-call shifts from 24 hours to 10–14 hours at KSUMC led to measurable improvements in workflow efficiency for discharged cases and was strongly preferred by residents. The findings align with global efforts to promote physician well-being without compromising care quality. While the project was limited in scope and duration, it demonstrates the feasibility and positive potential of such scheduling reforms within the Saudi context. Sustaining and expanding these changes will require continued institutional commitment, formal policy development, and ongoing evaluation guided by quality improvement principles. Abbreviations ACGME = Accreditation Council for Graduate Medical Education ANOVA = Analysis of Variance COVID-19 = Corona Virus 19 IQR = Interquartile Range IRB = Institutional Review Board KSUMC = King Saud University Medical City QI = Quality Improvement SPSS = Statistical Product and Service Solutions Declarations Ethical approval and consent to participate: This study was approved by the Institutional Review Board (IRB) of King Saud University—College of Medicine under application number E-24-9108. All data were gathered retrospectively and encrypted to protect participants’ confidentiality, and only the research team had access to the data for analysis. King Saud University—College of Medicine IRB waived the need for informed consent because the data were initially intended for departmental quality improvement purposes, which participants were aware of, and the retrospective data collection included on-call shift preferences and specific assessment timings, with no identifying information. This study adheres to the Declaration of Helsinki. Participant consent for publication: Not applicable . Information gathered does not compromise autonomy. Author consent for publication: The Authors gave their consent for publication. Availability of data and materials: All the data for this study will be made available upon reasonable request. Competing interests: The authors declare that they have no competing interests Funding: No funding required for this study. Author Contributions: All authors contributed significantly to the study’s design, data acquisition, analysis, and interpretation. They participated in drafting and revising the manuscript for critical intellectual content, approved the final version for publication, and agreed to take accountability for all aspects of the work. All authors have read and agreed to the published version of the manuscript. Acknowledgements: A special thank you to all the residents and staff who completed the data sheets. Artificial Intelligence Use Disclaimer: AI-based tools were used to generate this manuscript to assist with language refinement, drafting, and text formatting. All content was reviewed and validated by the authors to ensure accuracy and compliance with academic standards. Data analysis and interpretation were performed independently, without the use of AI tools. References McHill AW, Czeisler CA, Shea SA. Resident physician extended work hours and burnout. Sleep. 2018. 41(8):zsy112. Balch CM, et al.. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371–376. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385. Walker MP. The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009;1156:168-197. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838-1848. Rössler W. Stress, burnout, and job dissatisfaction in mental health workers. Eur Arch Psychiatry Clin Neurosci. 2012;262:2. Alkhamees AA, Assiri H, Alharbi HY, Nasser A, Alkhamees MA. Burnout and depression among psychiatry residents during COVID-19 pandemic. Hum Resour Health 2021; 19(1): 46. Al-Maddah EM, Al-Dabal BK, Khalil MS. Prevalence of sleep deprivation and relation with depressive symptoms among medical residents in King Fahd University Hospital, Saudi Arabia. Sultan Qaboos Univ Med J. 2015;15 Alsohime FM. Pediatric residents' perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey. Saudi Med J. 2019;40(10):1040-1044. Rosenbaum L, Lamas D, Residents' Duty Hours-Toward an Empirical Narrative. N Engl J Med 2012;367:2044-2049. Nasca TJ, Day SH, Amis ES Jr, ACGME duty hour task force. The new recommendations on duty hours from the ACGME task force. N Engl J Med. 2010;363(2):e3. Saudi Commission for Health Specialties. Saudi Board of Psychiatry Curriculum. 2015. Available form: https://scfhs.org.sa/sites/default/files/2022-01/Psychiatry%20-.pdf Additional Declarations No competing interests reported. Supplementary Files Questionnairefordutyoncallhours.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 17 Apr, 2026 Reviewers agreed at journal 17 Apr, 2026 Reviewers invited by journal 21 Jan, 2026 Editor assigned by journal 19 Dec, 2025 Editor invited by journal 17 Dec, 2025 Submission checks completed at journal 17 Dec, 2025 First submitted to journal 17 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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00:07:27","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":57416,"visible":true,"origin":"","legend":"","description":"","filename":"d89c51c6f89e4834b64a6277d8dca2d11structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/ff7283587222057ec85b615e.xml"},{"id":101206222,"identity":"ebb3f3fb-63dc-457f-9a06-5cd3723fefbe","added_by":"auto","created_at":"2026-01-27 09:55:41","extension":"html","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65506,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/8609491d812ee1d2988ec7e6.html"},{"id":101171159,"identity":"0332db58-86f9-44e4-84d8-8411f699757b","added_by":"auto","created_at":"2026-01-27 00:07:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19940,"visible":true,"origin":"","legend":"\u003cp\u003eTime between accepting consultation and seeing the patient in minutes across months.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/7e53bf708726045851f86f80.png"},{"id":101206251,"identity":"c486d974-ec09-49a1-afbf-ecd01a7ddcde","added_by":"auto","created_at":"2026-01-27 09:55:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":19083,"visible":true,"origin":"","legend":"\u003cp\u003eTime between finalizing the plan and accepting the consultation in minutes across months.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/cb0bee88d10f741675f97bf3.png"},{"id":101208494,"identity":"4b472bc5-3626-455d-acd4-3a7ba3e636f5","added_by":"auto","created_at":"2026-01-27 10:10:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639606,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/06e59407-fd2b-45e6-839c-a0ae5ab94324.pdf"},{"id":101207073,"identity":"76f8e147-fcb4-4faf-88a6-e39ced9276f4","added_by":"auto","created_at":"2026-01-27 09:57:16","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1683927,"visible":true,"origin":"","legend":"","description":"","filename":"Questionnairefordutyoncallhours.docx","url":"https://assets-eu.researchsquare.com/files/rs-8206621/v1/8c552cbaa661ee1a13dfc055.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of switching from 24-hour on-call shifts for psychiatry residents to 10-14-hour shifts on quality of care and workflow","fulltext":[{"header":"Background","content":"\u003cp\u003eThe well-being of physicians, particularly those in training such as residents, is a critical aspect of healthcare that directly impacts the quality of patient care. Long shifts and on-call duties are intrinsic to medical training but pose significant challenges to physician well-being. Hence, we examined the effects of extended work hours on the mental and physical health of medical trainees, with a focus on improving healthcare quality.\u003c/p\u003e \u003cp\u003eLong shifts have been linked to affecting mental health among physicians. Studies show that extended duty hours lead to burnout, a syndrome characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). If left unattended, burnout can escalate to substance use, depression, and, in severe cases, suicide (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Nearly half of all physicians experience burnout, with residents and early-career physicians being particularly vulnerable (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe physical toll of long shifts on physicians is equally concerning. Prolonged hours can lead to chronic sleep deprivation, and it has been noted that sleep-deprived individuals exhibit reduced attention, slower reaction times, and impaired memory, which are critical faculties for physicians (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These impairments can lead to increased medical errors, adversely affecting patient safety and the quality of care.\u003c/p\u003e \u003cp\u003eA study demonstrated that interns working traditional schedules with extended shifts made 36% more serious medical errors compared to those with shorter shifts (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePsychiatry trainees bear additional and distinct burdens. These include the continual efforts required to build therapeutic connections with patients, the perceived stigma associated with the field, personal safety concerns due to potential violence from patients, and the emotional weight of patient suicides (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlkhamees et al. found that burnout symptoms were found in 27.3% of psychiatric residents, and another 27.3% had depressive symptoms, while 16.5% experienced both, in a study that took place in Saudi Arabia during the COVID-19 outbreak (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Saudi Arabia, a study focusing on medical residents at King Fahd University Hospital revealed a high prevalence of sleep deprivation, which was significantly associated with depressive symptoms, advocating for the revision of regulations concerning working hours and night shifts for medical residents (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Additionally, a study examining pediatric residents' perceptions of the 24-hour on-call system found that prolonged on-call duties negatively affected their well-being, education, and patient safety, and that the majority of residents preferred not to continue with the 24-hour on-call system (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Training programs should consider exploring reforms to resident duty hours and assessing alternative on-call models to enhance resident well-being and training, as well as improve patient care.\u003c/p\u003e \u003cp\u003eThe U.S. medical residency training system began at Johns Hopkins in 1889, with residents living in hospitals and working extremely long hours; by the mid-1900s, residents routinely worked over 100 hours per week. Efforts to reform these conditions began with a 1975 strike in New York City and accelerated after the 1984 Libby Zion case, culminating in the Bell Commission's 1987 recommendation of an 80-hour workweek. The ACGME gradually implemented these limits across specialties, culminating in nationwide duty-hour regulations in 2003 and further restricting intern shifts to 16 hours in 2011, reflecting a century-long evolution toward safer and more humane working conditions for residents (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 2011, the Accreditation Council for Graduate Medical Education (ACGME) Task Force implemented new recommendations on duty hours, with a maximum period of duty, limiting continuous duty to 24 hours with an additional four hours for transition and handover activities for intermediate and senior residents, and not to exceed 16 hours for junior residents. This update marks a significant departure from the 2003 recommendations, which allowed for up to 30 hours of continuous duty. This shift reflects a growing recognition within the medical community of the importance of addressing physician well-being and ensuring adequate rest periods to optimize patient care quality (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e The Saudi Commission for Health Specialties has established specific guidelines for duty-hour regulations within the psychiatry program, while adhering to longstanding traditions. These guidelines specify that on-call duties must align with the hospital's designated duty hours policies and procedures. On-call responsibilities are scheduled no more frequently than every third night, averaged over four weeks. The duration of on-call hospital duties is limited to 24 consecutive hours. Following this period, residents may continue for up to six additional hours to engage in educational activities, transfer patient care, manage outpatient clinics, and ensure continuity of medical care. Importantly, no new patients will be assigned after 24 hours of continuous duty (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAddressing systemic issues contributing to physician burnout requires ongoing attention from policymakers. Future research should focus on the long-term impacts of duty hour reforms and innovative well-being strategies. Investing in programs that promote work-life balance is essential for sustainable healthcare systems that prioritize both patient care and physician well-being. Tailored interventions are crucial for residency and psychiatry trainees, who are particularly affected by long shifts. Through quality improvement initiatives and policy adjustments, physician well-being can be improved, leading to better patient care outcomes. Ongoing research and innovation are key to developing sustainable solutions for medical professionals' health and effectiveness.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design, Participants, and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilized a retrospective cohort design to evaluate the effect of switching from 24-hour on-call shifts to 10 to 14-hour shifts on quality of care and workflow. This study was conducted within the Psychiatry Residency Program at King Saud University Medical City in Riyadh, Saudi Arabia. It targeted psychiatry residents in postgraduate years 1 through 4 who rotated between January and March 2024. Inclusion criteria involved on-call reports from residents on duty during this period, with no exclusions. No identifying data was collected, and informed consent was deemed unnecessary.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eProcedure and Data Collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using Google Sheets, developed and overseen by the chief resident, and were reviewed by the training committee (Appendix 1). The Google Sheets link was distributed to all on-call residents, who were required to document specific details for each ER consultation, including the time of accepting the consultation, the time of seeing the patient, the time of finalizing the management plan, and the disposition. The process was done over three months in 2024: January, February, and March. During this time, on-call shifts were adjusted each month: 24 hours in January, 12 hours in February, and 10 to 14 hours in March. By the end of each shift, feedback on the shift changes was collected from all residents using a Google Forms questionnaire. This information was initially intended to serve as evidence to support the shift duration change, which was part of an internal quality improvement project. The positive impact of the shift duration change was noticeable, prompting the research team to obtain Institutional Review Board approval to access the data for publication, as the 10 to 14-hour model remains the implemented model at our institution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData analyses were performed using SPSS version 23. Data on time in this study were presented in minutes rather than hours and summarized using the median and interquartile range. The difference between months was assessed using the Kruskal-Wallis test for nonparametric numeric variables.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 116 consultations were received across three months: January (n=58, 50%), February (n=28, 24%), and March (n=30, 26%). Most of these shifts ended with discharge (n=78, 67%), and the third with admission (n=36, 31%). \u0026nbsp; Overall, the median time from accepting the consultation to seeing the patient was 22 minutes (IQR 10-45), and the median time from finalizing the plan to accepting the consultation was 128.5 minutes (IQR 97-180). \u0026nbsp;The median time by month and status is reported in Table 1, and visualized in Figures 1 and 2.\u003c/p\u003e\n\u003cp\u003eUsing ANOVA, we examined the time difference between months in each status. Regarding admission, there is no difference in time between accepting the consultation and seeing the patient over months (P value = 0.237). Additionally, there is no difference in time between finalizing the plan and accepting the consultation across months (P-value = 0.913).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding discharge, there is no difference in time between accepting the consultation and seeing the patient across months (P value = 0.445). However, there is a difference in time between finalizing the plan and accepting the consultation across months, P-value (0.007). The longest time was in February, followed by January, then March. See Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1: Median and IQR of time in each month\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003eTime between accepting the consultation and seeing the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 155px;\"\u003e\n \u003cp\u003eTime between finalizing the plan and accepting the consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMonth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eStatus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003ecount\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003emedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003emedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAdmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;13 - 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e103 - 180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;10 - 50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e91.5 - 192\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eEhalah,Absconded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e22 - 22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e122 - 122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAdmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;10 - 100.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e50 - 221.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e18 - 64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e125 - 200\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eEhalah,Absconded\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e17 - 17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e107 - 107\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAdmission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;8 - 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e85 - 187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 131px;\"\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 52px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 86px;\"\u003e\n \u003cp\u003e14 - 40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 75px;\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e91 - 125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Table 2: Mean difference of time in minutes across months for admission decision and discharge decision.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"569\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003eStd. Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003eSig.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 522px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdmission\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003eTime between accepting the consultation and seeing the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e29.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e19.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.237\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e55.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e87.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e21.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e23.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003eTime between finalizing the plan and accepting the consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e149.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e82.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e135.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e108.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e159.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e126.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"bottom\" style=\"width: 522px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDischarge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003eTime between accepting the consultation and seeing the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e35.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e29.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.445\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e46.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e67.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e30.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e24.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003eTime between finalizing the plan and accepting the consultation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eJanuary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e147.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e65.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eFebruary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e162.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e52.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 223px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMarch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 81px;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 57px;\"\u003e\n \u003cp\u003e108.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e27.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis quality improvement (QI) project evaluated the impact of reducing psychiatry residents\u0026rsquo; on-call shift lengths from 24 hours to 10\u0026ndash;14 hours at King Saud University Medical City (KSUMC). Over three months, workflow data demonstrated a significant improvement in the time from consultation acceptance to plan finalization for discharged patients (p\u0026thinsp;=\u0026thinsp;0.007), while no significant differences were observed for admissions. Qualitative feedback from residents highlighted reduced fatigue and better focus during shorter shifts. However, some challenges were noted during the month of Ramadan, when altered sleep\u0026ndash;wake schedules affected alertness and workflow. Consultants emphasized the need for clearer handover policies and standardized end-of-shift responsibilities.\u003c/p\u003e \u003cp\u003eThe improvement in discharge-related workflow efficiency likely reflects reduced cognitive fatigue, enabling residents to make decisions more effectively and maintain concentration throughout the shift. Shorter shifts appeared to benefit cases involving patient discharge more than those requiring admission. Admission workflows typically involve more complex clinical and administrative processes, multidisciplinary coordination, and bed availability issues, which may limit the influence of duty-hour reforms on these timelines.\u003c/p\u003e \u003cp\u003eOne possible explanation is that discharged cases are more sensitive to residents\u0026rsquo; alertness and emotional energy. Managing these cases often demands nuanced communication, empathy, and clinical judgment, all of which depend heavily on cognitive freshness. By contrast, \u0026ldquo;workflow-complex\u0026rdquo; tasks such as admissions may be constrained by systemic or procedural factors rather than by individual cognitive performance. Thus, while intrinsically complex cases (e.g., severe psychiatric admissions) naturally require time, the efficiency gains observed in discharge cases suggest that well-rested residents are better able to process, decide, and finalize management plans.\u003c/p\u003e \u003cp\u003eOverall, the findings support the hypothesis that the impact of duty-hour reforms may depend on the nature of the clinical task\u0026mdash;with cognitively demanding but time-sensitive decisions benefiting most from reduced fatigue, while system-driven processes remain less affected.\u003c/p\u003e \u003cp\u003eThese findings are consistent with international evidence linking reduced duty hours to improved cognitive performance, decreased burnout, and maintained or enhanced quality of care. Landrigan et al. (2004) demonstrated a 36% reduction in serious medical errors after limiting intern work hours, highlighting the safety benefits of mitigating fatigue (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Although the present study did not measure adverse events, the improvement in workflow efficiency may reflect similar underlying mechanisms of enhanced alertness and decision quality.\u003c/p\u003e \u003cp\u003eSaudi-based studies have also shown that prolonged on-call duties negatively affect resident well-being and patient safety. For instance, Al-Maddah et al. (2015) and Alsohime (2019) reported that extended shifts were associated with sleep deprivation, depressive symptoms, and reduced educational satisfaction. Locally, burnout prevalence among psychiatry residents has been particularly high, emphasizing the need for structural interventions that support physician wellness (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnlike many cross-sectional studies in the region, this project used a longitudinal, intervention-based approach, assessing operational metrics before and after implementation. It therefore contributes practical, context-specific evidence for duty-hour reform in Saudi psychiatry training programs.\u003c/p\u003e \u003cp\u003eThe progressive improvement in discharge-related efficiency across months suggests early adaptation to the new schedule. For sustainability, formalizing handover procedures, establishing precise referral cutoffs near shift end, and defining structured post-call relief protocols will be essential. Consultant feedback emphasized that consistent handover communication and shared expectations between residents and supervisors are critical for maintaining continuity of care.\u003c/p\u003e \u003cp\u003eThe number of residents available to staff multiple shorter shifts may influence scalability. Departments with smaller cohorts may face logistical challenges in splitting 24-hour coverage into multiple shorter rotations. Institutional support in workforce planning, duty scheduling, and resource allocation will therefore determine long-term success.\u003c/p\u003e \u003cp\u003eFuture research should evaluate the impact of shortened shifts over longer periods, ideally extending beyond Ramadan to minimize seasonal variation. Studies should also incorporate validated instruments to assess resident-level outcomes (e.g., burnout, sleep quality, psychological well-being), patient-level outcomes (e.g., satisfaction, adverse events, treatment adherence), and system-level outcomes (e.g., consultant satisfaction, teaching quality, interdepartmental response times).\u003c/p\u003e \u003cp\u003eStructured surveys and focus groups could provide deeper insights into the perceived benefits and challenges of the new model. Additionally, implementing standardized handover protocols and clarifying consultation responsibilities at shift changes will strengthen workflow consistency. Including patient safety metrics and qualitative analyses of decision quality will further enrich the understanding of the broader implications of duty-hour reform.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eSeveral limitations should be considered when interpreting these findings. First, the evaluation period was relatively brief, and it coincided with Ramadan (March 2024), which may have influenced residents\u0026rsquo; sleep patterns, energy levels, and overall performance. Second, the absence of a control group limits the ability to establish causality for the observed improvements. Feedback was obtained through informal surveys rather than validated instruments, and no standardized tools were used to assess burnout, sleep quality, or well-being. In addition, outcome measures were confined to time-based metrics; indicators of patient safety and quality of care were not examined. The study sample was heterogeneous, including residents with varying employment statuses, training levels, and prior experiences, which may have affected performance outcomes. Finally, concerns related to handover clarity, referral cutoffs, and post-call duties were noted but not systematically measured. These limitations underscore the need for a more comprehensive and methodologically rigorous evaluation to fully capture the impact of duty-hour reform on both resident performance and patient care outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eReducing psychiatry residents\u0026rsquo; on-call shifts from 24 hours to 10\u0026ndash;14 hours at KSUMC led to measurable improvements in workflow efficiency for discharged cases and was strongly preferred by residents. The findings align with global efforts to promote physician well-being without compromising care quality. While the project was limited in scope and duration, it demonstrates the feasibility and positive potential of such scheduling reforms within the Saudi context. Sustaining and expanding these changes will require continued institutional commitment, formal policy development, and ongoing evaluation guided by quality improvement principles.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eACGME =\u0026nbsp;\u003c/strong\u003eAccreditation Council for Graduate Medical Education\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANOVA =\u0026nbsp;\u003c/strong\u003eAnalysis of Variance\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOVID-19 =\u0026nbsp;\u003c/strong\u003eCorona Virus 19\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIQR =\u0026nbsp;\u003c/strong\u003eInterquartile Range\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIRB =\u0026nbsp;\u003c/strong\u003eInstitutional Review Board\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKSUMC =\u0026nbsp;\u003c/strong\u003eKing Saud University Medical City\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQI =\u0026nbsp;\u003c/strong\u003eQuality Improvement\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSPSS =\u0026nbsp;\u003c/strong\u003eStatistical Product and Service Solutions\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Institutional Review Board (IRB) of King Saud University\u0026mdash;College of Medicine under application number E-24-9108. All data were gathered retrospectively and encrypted to protect participants\u0026rsquo; confidentiality, and only the research team had access to the data for analysis. King Saud University\u0026mdash;College of Medicine IRB waived the need for informed consent because the data were initially intended for departmental quality improvement purposes, which participants were aware of, and the retrospective data collection included on-call shift preferences and specific assessment timings, with no identifying information. This study adheres to the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant consent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eInformation gathered does not compromise autonomy.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor consent for publication:\u0026nbsp;\u003c/strong\u003eThe\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eAuthors gave their consent for publication.\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll the data for this study will be made available upon reasonable request.\u003cbr\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Competing interests:\u003c/strong\u003e The authors declare that they have no competing interests\u003cbr\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No funding required for this study.\u0026nbsp;\u003cbr\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;Author Contributions:\u003c/strong\u003e All authors contributed significantly to the study\u0026rsquo;s design, data acquisition, analysis, and interpretation. They participated in drafting and revising the manuscript for critical intellectual content, approved the final version for publication, and agreed to take accountability for all aspects of the work. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eA special thank you to all the residents and staff who completed the data sheets.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eArtificial Intelligence Use Disclaimer:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAI-based tools were used to generate this manuscript to assist with language refinement, drafting, and text formatting. All content was reviewed and validated by the authors to ensure accuracy and compliance with academic standards. Data analysis and interpretation were performed independently, without the use of AI tools.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMcHill AW, Czeisler CA, Shea SA. Resident physician extended work hours and burnout. Sleep. 2018. 41(8):zsy112.\u003c/li\u003e\n\u003cli\u003eBalch CM, et al.. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371\u0026ndash;376.\u003c/li\u003e\n\u003cli\u003eShanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.\u003c/li\u003e\n\u003cli\u003eWalker MP. The role of sleep in cognition and emotion. Ann N Y Acad Sci. 2009;1156:168-197.\u003c/li\u003e\n\u003cli\u003eLandrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns\u0026apos; work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351(18):1838-1848.\u003c/li\u003e\n\u003cli\u003eR\u0026ouml;ssler W. Stress, burnout, and job dissatisfaction in mental health workers. Eur Arch Psychiatry Clin Neurosci. 2012;262:2.\u003c/li\u003e\n\u003cli\u003eAlkhamees AA, Assiri H, Alharbi HY, Nasser A, Alkhamees MA. Burnout and depression among psychiatry residents during COVID-19 pandemic. \u003cem\u003eHum Resour Health\u003c/em\u003e 2021; 19(1): 46.\u003c/li\u003e\n\u003cli\u003eAl-Maddah EM, Al-Dabal BK, Khalil MS. Prevalence of sleep deprivation and relation with depressive symptoms among medical residents in King Fahd University Hospital, Saudi Arabia. Sultan Qaboos Univ Med J. 2015;15\u003c/li\u003e\n\u003cli\u003eAlsohime FM. Pediatric residents\u0026apos; perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety. A national survey. Saudi Med J. 2019;40(10):1040-1044.\u003c/li\u003e\n\u003cli\u003eRosenbaum L, Lamas D, Residents\u0026apos; Duty Hours-Toward an Empirical Narrative. N Engl J Med 2012;367:2044-2049.\u003c/li\u003e\n\u003cli\u003eNasca TJ, Day SH, Amis ES Jr, ACGME duty hour task force. The new recommendations on duty hours from the ACGME task force. N Engl J Med. 2010;363(2):e3.\u003c/li\u003e\n\u003cli\u003eSaudi Commission for Health Specialties. Saudi Board of Psychiatry Curriculum. 2015. Available form: https://scfhs.org.sa/sites/default/files/2022-01/Psychiatry%20-.pdf \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Quality improvement, on-call, psychiatry, residents, medical training, shift work","lastPublishedDoi":"10.21203/rs.3.rs-8206621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8206621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eExtended on-call duty hours for residents are associated with burnout and potential risks to patient care. This quality improvement (QI) project evaluated the effect of reducing psychiatry residents\u0026rsquo; on-call shifts from 24 hours to 10\u0026ndash;14 hours on clinical workflow efficiency at King Saud University Medical City (KSUMC).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort design evaluated the effects of the shift change among psychiatry residents in January (24-hour shifts), February (12-hour shifts), and March (10\u0026ndash;14-hour shifts). Residents documented time metrics for 116 consultations. Key outcomes were time from consultation acceptance to patient viewing and the time from consultation acceptance to plan finalization, reported in median minutes and interquartile range (IQR). The Kruskal-Wallis test was used to analyze differences between months.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 116 consultations were received. The majority (67%) resulted in patient discharge. While admitted patients showed no significant difference, the time from consultation acceptance to plan finalization for discharged patients showed a statistically significant improvement across the three months (P\u0026thinsp;=\u0026thinsp;0.007). The median time for this metric was 145 minutes in January, 150 minutes in February, and the shortest was 118 minutes in March. Residents gave positive qualitative feedback, noting reduced fatigue.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eReducing on-call shift duration was feasible and improved workflow efficiency for discharge-related cases, suggesting that well-rested residents are better able to handle cognitively demanding, time-sensitive tasks. The findings support local and global efforts to prioritize physician well-being without compromising care quality and demonstrate the positive potential of duty-hour reform.\u003c/p\u003e","manuscriptTitle":"The effect of switching from 24-hour on-call shifts for psychiatry residents to 10-14-hour shifts on quality of care and workflow","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-27 00:07:22","doi":"10.21203/rs.3.rs-8206621/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-17T19:52:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319917791753329832519579689732428723306","date":"2026-04-17T14:12:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-22T01:03:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-19T17:22:58+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-17T12:33:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T09:50:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2025-12-17T09:41:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e4140513-70db-4cca-b50e-2a7a14b3c402","owner":[],"postedDate":"January 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-27T00:07:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-27 00:07:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8206621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8206621","identity":"rs-8206621","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}