Whats 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 its 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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