What’s New in the Patient Safety World

April 2018

Radiologists Get Fatigued, Too

 

 

One of our most frequent topics has been the impact of fatigue on performance and its contribution to medical errors. No one is immune to the detrimental effect of fatigue on performance and it’s no different for radiologists. A recent study (Hanna 2018) used a tool for measuring fatigue and advance eye tracking technology to assess the performance of radiologists (both attendings and residents). The goal was to determine the effect of overnight shifts on performance.

 

During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. The Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after overnight shifts. Not surprisingly, participants demonstrated worse diagnostic performance in the fatigued versus not-fatigued state. Viewing time per case was significantly prolonged when the radiologists were fatigued. Mean total fixations generated during the search increased by 60% during fatigued sessions. Mean time to first fixate on bone fractures increased by 34% during fatigued sessions. Moreover, dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased. Effects of fatigue were more pronounced in residents.

 

The authors conclude that further research is needed to address and reverse the impact of such fatigue-related changes. They speculate that environmental changes (eg. lighting) and activity changes (eg. periodic breaks, moving around, etc.) might help mitigate the adverse effects of fatigue on performance.

 

 

Some of our other columns on the role of fatigue in Patient Safety:

 

November 9, 2010      “12-Hour Nursing Shifts and Patient Safety”

April 26, 2011             “Sleeping Air Traffic Controllers: What About Healthcare?”

February 2011             “Update on 12-hour Nursing Shifts”

September 2011          “Shiftwork and Patient Safety

November 2011          “Restricted Housestaff Work Hours and Patient Handoffs”

January 2012               “Joint Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety

January 3, 2012           “Unintended Consequences of Restricted Housestaff Hours”

June 2012                    “June 2012 Surgeon Fatigue”

November 2012          “The Mid-Day Nap”

November 13, 2012    “The 12-Hour Nursing Shift: More Downsides”

July 29, 2014              “The 12-Hour Nursing Shift: Debate Continues”

October 2014              “Another Rap on the 12-Hour Nursing Shift”

December 2, 2014       “ANA Position Statement on Nurse Fatigue”

August 2015               “Surgical Resident Duty Reform and Postoperative Outcomes”

September 2015          “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”

September 6, 2016      “Napping Debate Rekindled”

April 18, 2017             “Alarm Response and Nurse Shift Duration”

July 11, 2017              “The 12-Hour Shift Takes More Hits”

 

 

Some of our other columns on housestaff workhour restrictions:

 

December 2008           “IOM Report on Resident Work Hours”

February 26, 2008       “Nightmares: The Hospital at Night”

January 2010               “Joint Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety

January 2011               “No Improvement in Patient Safety: Why Not?”

November 2011          “Restricted Housestaff Work Hours and Patient Handoffs”

January 3, 2012           “Unintended Consequences of Restricted Housestaff Hours”

June 2012                    “Surgeon Fatigue”

November 2012          “The Mid-Day Nap”

December 10, 2013     “Better Handoffs, Better Results”

April 22, 2014             “Impact of Resident Workhour Restrictions”

January 2015               “More Data on Effect of Resident Workhour Restrictions”

August 2015               “Surgical Resident Duty Reform and Postoperative Outcomes”

September 2015          “Surgery Previous Night Does Not Impact Attending Surgeon Next Day”

March 2016                 “Does the Surgical Resident Hours Study Answer Anything?”

 

 

 

Our previous columns on the 12-hour nursing shift:

 

November 9, 2010      “12-Hour Nursing Shifts and Patient Safety”

February 2011             “Update on 12-hour Nursing Shifts”

November 13, 2012    “The 12-Hour Nursing Shift: More Downsides”

July 29, 2014              “The 12-Hour Nursing Shift: Debate Continues”

October 2014              “Another Rap on the 12-Hour Nursing Shift”

December 2, 2014       “ANA Position Statement on Nurse Fatigue”

September 29, 2015    “More on the 12-Hour Nursing Shift”

July 11, 2017              “The 12-Hour Shift Takes More Hits”

 

 

 

References:

 

 

Hanna TN,  Zygmont ME, Peterson R, et al. The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance. J Am Coll Rad 2018; Article in Press January 21, 2018

http://www.jacr.org/article/S1546-1440(17)31661-7/fulltext

 

 

 

 

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