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Our many columns listed below have highlighted the role fatigue in healthcare workers plays in medical errors and patient safety. A major problem is that we, ourselves, are not very good at recognizing when we are fatigued to a point that we are putting our patients in jeopardy. Weve always suspected we will ultimately adopt technology as a means to identify fatigue earlier. In our July 29, 2014 Patient Safety Tip of the Week The 12-Hour Nursing Shift: Debate Continues we predicted that someday we will have the equivalent of the brief sobriety or breathalyzer test that can rapidly identify healthcare workers who are impaired by fatigue. We envision that at regular intervals beyond 8 hours (maybe even sooner) or during periods of prolonged concentration the healthcare worker will get buzzed on his/her smartphone and have to complete some simple test of reaction times or attention span. If the worker scores outside the established threshold the hospital will need to have resources in place to take over duties of that worker (completely or at least temporarily until fatigue is alleviated by, for example, a nap).
When driving long distances or at night, we use a cellphone app that uses the camera to focus on our face. When it detects any degree of eyelid drooping, it sounds an audible alarm to alert us. And it sounds an even louder alarm if it detects a repeat episode of eyelid drooping within a specified amount of time. But, obviously, we cant wait for eyelid drooping to identify fatigue in healthcare workers on the job.
Fortunately, there are a variety of other ocular phenomena that can be used to detect early fatigue. In addition to eyelid drooping, alteration of saccadic eye movements, changes in the blink rate, and changes in pupillary responses may be early signs of fatigue. In our December 2, 2014 Patient Safety Tip of the Week ANA Position Statement on Nurse Fatigue we noted there are other technologies that might do the trick. Studies have demonstrated alteration of saccadic eye movement metrics correlate with fatigue in several settings and studies in surgical residents confirmed such a correlation (Di Stasi 2014). Such a test could probably be easily adapted to most of todays smartphones.
April 2018 What's New in the Patient Safety World column Radiologists Get Fatigued, Too (Hanna 2018). The authors concluded 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.
Then, in our August 25, 2020 Patient Safety Tip of the Week The Off-Hours Effect in Radiology we noted some other studies assessing the impact of fatigue on radiologist performance.
So, its no surprise that researchers have chosen radiologists as a good population in which to study the use of oculometrics for assessment of fatigue. Belgian researchers have done just that (Ward 2021). They measured saccades, blink rate, and the percentage of eyelid closure over the pupil over time. Their setup included four displays, three RGB (red, green, blue) cameras, a gaze tracker, keyboard/mouse input (no keystrokes, only number of actions per second), and acoustic information. (The Ward article has a photo of the equipment setup used by the Belgian researchers.) And the radiologists also completed a subjective assessment of fatigue every 20 minutes.
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 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 29, 2015 More on the 12-Hour Nursing Shift
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
February 13, 2018 Interruptions in the ED
April 2018 Radiologists Get Fatigued, Too
August 2018 Burnout and Medical Errors
September 4, 2018 The 12-Hour Nursing Shift: Another Nail in the Coffin
August 2020 New Twist on Resident Work Hours and Patient Safety
August 25, 2020 The Off-Hours Effect in Radiology
September 2020 Daylight Savings Time Impacts Patient Safety?
Di Stasi LL, McCamy MB, Macknik, SL, et al. Saccadic Eye Movement Metrics Reflect Surgical Residents' Fatigue. Annals of Surgery 2014; 259(4): 824-829
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 Radiol 2018; 15(12): 1709-1716
Ward P. Belgian team develops novel way to assess fatigue. AuntMinnieEurope.com 2021; January 12, 2021
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