The Impact of Housestaff Fatigue on Occupational and Patient Safety
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.
[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.0Comments 3Citations
- "Training physicians are susceptible to fatigue and sleep deprivation due to their prolonged work hours and rotating work schedules . Residency work hours have become the focus of numerous comprehensive reviews2345678. 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. Research on physicians sleep deprivation has primarily focused on the detrimental impact of fatigue on patient care [9,10] . "
[Show abstract] [Hide abstract] ABSTRACT: In Canada, as in many other jurisdictions worldwide, physicians in training have a dual role of a learner and clinical care provider. The number of hours worked by residents (resident duty hours) are the subject of much national and international debate. In 2012, the Towards a Pan-Canadian Consensus on Resident Duty Hours project was launched with two key objectives: 1) To assemble the available evidence on the issue; and 2) To facilitate a national, consensus-building process among educators, governments, policy makers, patient safety experts, and others, to come to a pan-Canadian statement on resident duty hours issues, directions, and best practices. This report, and the position of the National Steering Committee and six Expert Working Groups, is intended to outline recommendations and a path forward that optimizes patient care and training for the 21st century.0Comments 0Citations
- "Patient safety is an incredibly complex outcome and admittedly it is very difficult to assess resident duty hour reforms as a unique impact for the purposes of accurate and directive study. In particular, several studies stated that the lack of data of sufficient quality (Moonesinghe et al. 2011) or quantity (Baldwin et al. 2011; Curet 2008; Fletcher et al. 2004; Lockley et al. 2006; Mountain et al. 2007) made it difficult to make conclusive statements on the relationship between reduced duty hours and patient safety. "
[Show abstract] [Hide abstract] ABSTRACT: This review describes some of the literature pertaining to sleep deprivation, shift working, and heat exposure. Consequences of each on human cognitive function, particularly with respect to vigilance and attentional capacity are reviewed. Individually, each of these factors is known to impair human cognition; however, we propose the possibility that for miners working in hot underground environments and who are assigned to rotating shifts, the combination may leave miners with significant degrees of fatigue and decreased ability to focus on tasks. We suggest that such decreased capacity for vigilance is a source of concern in an occupational health and safety context.0Comments 1Citation
- "With respect to risk management, sleepy shift workers who are driving home after a shift may expose their employers to liability issues. In the United States, fatigued drivers who were involved in personal injury car accidents have been held jointly responsible with their employers for injuries to others . In summary, the literature reviewed here raises the hypothesis that shift working miners' attention and vigilance is reduced as a result of their normal employment requirements. "