{
  "version": 1,
  "checkedOn": "2026-10-24",
  "scope": "Original synthetic staff workload, relief and handoff workflow. Not a validated health intervention. Non-double-blind evidence is context only; the strict efficacy-claim gate remains held.",
  "rights": {
    "materialIncluded": "Original synthesis and bibliographic references only",
    "articleOrQuestionnaireContentImported": false,
    "figuresImported": false,
    "thirdPartyLogosImported": false,
    "rawResearchDataImported": false,
    "allFullTextAndInstrumentImportsBlockedUntilExactRightsReview": true,
    "specificLicenseObservations": [
      {
        "sourceRegister": "/people-care-evidence.json",
        "sourceId": "P02",
        "status": "Primary publisher reserves rights. No article, manual or instrument imported."
      },
      {
        "sourceRegister": "/people-care-evidence.json",
        "sourceId": "P05",
        "status": "Article reports CC BY 4.0. No separate policy, assets or instruments are imported or treated as cleared."
      }
    ]
  },
  "sources": [
    {
      "id": "H01",
      "citation": "Djupedal ILR et al. Work-schedule changes and insomnia, sleepiness and fatigue. Sleep. 2024;47(7):zsae086.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/38581363/",
      "doi": "10.1093/sleep/zsae086",
      "design": "Cluster-randomized trial",
      "masking": "Workers could know their schedule; not double-blind.",
      "finding": "Fewer short turnarounds yielded small improvements in insomnia (d=-0.13) and sleepiness (d=-0.14). Work-related fatigue did not improve significantly.",
      "limitations": "Substantial follow-up loss; a single hospital setting; self-reported endpoints. The study turnaround boundary is not a universal staffing rule.",
      "fundingAndConflicts": "Not fully checked in the accessible source; verify disclosures before approval.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    },
    {
      "id": "H02",
      "citation": "Landrigan CP et al. Effect on Patient Safety of a Resident Physician Schedule without 24-Hour Shifts. N Engl J Med. 2020;382:2514–2523.",
      "url": "https://www.nejm.org/doi/abs/10.1056/NEJMoa1900669",
      "doi": "10.1056/NEJMoa1900669",
      "design": "Multicentre cluster-randomized crossover trial",
      "masking": "Schedule allocation apparent to staff; not double-blind.",
      "finding": "Serious errors were more frequent in the shorter-shift intervention overall (adjusted relative risk 1.53; 95% CI 1.37–1.72), with large differences between sites and changes in workload.",
      "limitations": "An implementation result, not proof that shorter shifts are inherently harmful. Resident findings cannot directly supply nurse, dietitian or kitchen staffing weights.",
      "fundingAndConflicts": "Not fully checked in the accessible source; verify disclosures before approval.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    },
    {
      "id": "H03",
      "citation": "Volpp KG et al. Protected sleep during overnight hospital duty. JAMA. 2012;308:2208–2217.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/23212498/",
      "doi": "10.1001/jama.2012.34490",
      "design": "Randomized trial of rotation blocks",
      "masking": "Participants knew whether protected sleep was available; not double-blind.",
      "finding": "Protected overnight sleep increased time asleep during the protected interval by approximately one hour and improved next-morning alertness.",
      "limitations": "Sleep and alertness endpoints do not establish fewer patient complications. Protected overnight sleep is not equivalent to an ordinary meal break.",
      "fundingAndConflicts": "Not fully checked in the accessible source; verify disclosures before approval.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    },
    {
      "id": "H04",
      "citation": "McHugh MD et al. Nurse-to-patient ratio policy and hospital outcomes. Lancet. 2021;397:1905–1913.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/33989553/",
      "doi": "10.1016/S0140-6736(21)00768-6",
      "design": "Prospective controlled policy evaluation; observational",
      "masking": "No double-blind randomization.",
      "finding": "Improved staffing was associated with better mortality, readmission and length-of-stay outcomes.",
      "limitations": "Nonrandom policy allocation and possible residual confounding. Do not convert this association into an individual patient risk estimate or a universal legal staffing ratio.",
      "fundingAndConflicts": "Not fully checked in the accessible source; verify disclosures before approval.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    },
    {
      "id": "H05",
      "citation": "Starmer AJ et al. Changes in Medical Errors after Implementation of a Handoff Program. N Engl J Med. 2014;371:1803–1812.",
      "url": "https://www.nejm.org/doi/full/10.1056/NEJMsa1405556",
      "doi": "10.1056/NEJMsa1405556",
      "design": "Multicentre before-and-after implementation study",
      "masking": "Not a double-blind randomized trial.",
      "finding": "The implementation period was associated with 23% fewer medical errors and 30% fewer preventable adverse events.",
      "limitations": "Training, observation and cultural changes formed a bundle. Paediatric resident handoffs do not directly validate adult nutrition transitions or a software checklist alone.",
      "fundingAndConflicts": "Government and other grant support; an unrestricted Pfizer education grant is disclosed on the publisher page.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    },
    {
      "id": "H06",
      "citation": "Kent KB et al. Hospital food-service workers’ psychosocial, organisational and environmental stressors. J Occup Environ Med. 2024;66:556–563.",
      "url": "https://pubmed.ncbi.nlm.nih.gov/38595305/",
      "doi": "10.1097/JOM.0000000000003108",
      "design": "Cross-sectional survey and interviews",
      "masking": "Not randomized or double-blind.",
      "finding": "Reported pressures included infection concerns, increased demands, unpredictable schedules and financial insecurity.",
      "limitations": "Context-specific reports do not show that a Care feature reduces distress. Do not infer a worker’s finances or mental state from operational records.",
      "fundingAndConflicts": "Not fully checked in the accessible source; verify disclosures before approval.",
      "copyrightUse": "Bibliographic information and original factual summary with link only. No article text, figures, questionnaire items, scoring keys or participant data imported.",
      "supportsCareEfficacyClaim": false
    }
  ],
  "broaderFeasibilityRegister": "/people-care-evidence.json",
  "plainLanguageReview": "/people-and-care/"
}