The Impact of Housestaff Fatigue on Occupational and Patient Safety

The Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Beitr├Ąge zur Klinik der Tuberkulose (Impact Factor: 2.27). 07/2007; 185(4):203-9. DOI: 10.1007/s00408-007-9010-5
Source: PubMed


Extended-duration work shifts (i.e., greater than 24 hours) for housestaff are a long-standing tradition. However, the resultant sleep deprivation and fatigue caused by these extreme work schedules pose potential threats to both physician and patient safety. We believe it is critical to understand the potential adverse consequences of housestaff fatigue to optimize shift schedules and reduce risks to both staff and patients.

1 Follower
6 Reads
  • Source
    • "Training physicians are susceptible to fatigue and sleep deprivation due to their prolonged work hours and rotating work schedules [1]. Residency work hours have become the focus of numerous comprehensive reviews [2-8]. The effect of sleep loss in the context of medical training is a topic that has generated considerable interest, as well as controversy, over the past two decades. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Sleep deprivation among training physicians is of growing concern; training physicians are susceptible due to their prolonged work hours and rotating work schedules. The aim of this study was to determine the prevalence of self-perceived sleepiness in emergency training physicians, and to establish a relationship between self-perceived sleepiness, and quality of life. Prospective survey in Ibn Sina University hospital Center in Morocco from January to April 2011 was conducted. Questionnaires pertaining to socio-demographic, general, and sleep characteristics were completed by training physician who ensured emergency service during the month preceding the survey. They completed the Epworth sleepiness scale (ESS) which assessed the self-perceived sleepiness, and the EuroQol-5 dimensions (EQ-5D) scale which assessed the general quality of life. Total 81 subjects (49 men and 32 women) were enrolled with mean age of 26.1 +/- 3.4 years. No sleepiness was found in 24.7% (n = 20), excessive sleepiness 39.5% (n = 32), and severe sleepiness in 35.8% (n = 29) of training physicians. After adjusting for multiple confounding variables, four independent variables were associated with poorer quality of life index in training physician; unmarried (Ss -0.2, 95% CI -0.36 to -0.02; P = 0.02), no physic exercise (Ss -0.2, 95% CI -0.39 to 0.006; P = 0.04), shift-off sleep hour less than 6 hours (Ss -0.13, 95% CI -0.24 to -0.02; P = 0.01), and severe sleep deprivation(Ss -0.2, 95% CI -0.38 to -0.2; P = 0.02). Nearly two third of training physicians had suffered from sleepiness. There is an association between poor quality of life and severe sleepiness in unmarried physicians, sleeping less than 6 hours in shift-off day, and doing no physical activity.
    Journal of Occupational Medicine and Toxicology 09/2013; 8(1):24. DOI:10.1186/1745-6673-8-24 · 1.62 Impact Factor
  • Source
    • "Sleep is shortened and disrupted prior to early morning shifts and following night shifts, or as a result of extended working hours, but these effects are often not separated from other influences on fatigue in shift work research. In a health care setting, differences in work schedules for junior doctors have been studied systematically (Barger et al., 2005; Lockley et al., 2006; Mountain et al., 2007 "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this review was to examine the evidence for the link between fatigue and safety, especially in transport and occupational settings. For the purposes of this review fatigue was defined as 'a biological drive for recuperative rest'. The review examined the relationship between three major causes of fatigue - sleep homeostasis factors, circadian influences and nature of task effects - and safety outcomes, first looking at accidents and injury and then at adverse effects on performance. The review demonstrated clear evidence for sleep homeostatic effects producing impaired performance and accidents. Nature of task effects, especially tasks requiring sustained attention and monotony, also produced significant performance decrements, but the effects on accidents and/or injury were unresolved because of a lack of studies. The evidence did not support a direct link between circadian-related fatigue influences and performance or safety outcomes and further research is needed to clarify the link. Undoubtedly, circadian variation plays some role in safety outcomes, but the evidence suggests that these effects reflect a combination of time of day and sleep-related factors. Similarly, although some measures of performance show a direct circadian component, others would appear to only do so in combination with sleep-related factors. The review highlighted gaps in the literature and opportunities for further research.
    Accident; analysis and prevention 03/2011; 43(2):498-515. DOI:10.1016/j.aap.2009.11.011 · 1.65 Impact Factor

  • Current opinion in pulmonary medicine 12/2008; 14(6):507-11. DOI:10.1097/MCP.0b013e3283165e81 · 2.76 Impact Factor
Show more