The Tao of Bao: A Randomised Controlled Trial Examining the Effect of Steamed Bun Consumption on Night-Call Inpatient Course and Mortality

Abstract

Background: Medical superstitions remain prevalent in today’s stressful and technology driven healthcare environment. These irrational beliefs commonly involve night calls, which are periods of volatile workload. In Singapore and Hong Kong, it is commonly held that consumption of steamed buns (“bao”) by on-call physicians is associated with increased patient admissions and mortality, due to a homonymous interpretation of the word “bao” in dialect. Materials and Methods: A prospective unblinded randomised controlled trial with a permuted block randomisation design was performed on weekdays over 6 weeks. Steamed buns or control food were offered to the internal medicine night-call team of a tertiary-care hospital on a nightly basis. Information on admissions and mortality was collected from the hospital electronic database. Data on sleep patterns and shift duration were obtained by interview. Results: There were no significant differences in the median number of hours slept on days on “bao” administration versus “control” intervention (2 ± median absolute variation of 1.5 h vs 2 ± 1.5 h, P = 0.30) or in the number of hours spent in the hospital (30.8 ± 1.9 h vs 30.5 ± 2.2 h, P = 0.09). There were no significant differences in the median number of general ward admissions per night (n = 73 ± 6 versus 71 ± 7 admissions, P = 0.35), monitored care unit admissions (4 ± 1.5 vs 4 ± 1.5 admissions, P = 0.65) or inpatient mortality (2 ± 1.5 vs 2 ± 1.5 deaths per night, P = 0.47). Conclusion: The consumption of steamed buns (“bao”) has no effect on inpatient admissions, mortality, or sleep duration on call. Regardless, our results indicate that the night call in Singapore remains a challenge in terms of workload and shift duration. Key words: Medical superstition, Night duty, Occupational medicine, Sleep deprivation