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Patient Safety Tip
of the Week
January 19, 2021
Technology
to Identify Fatigue?
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 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 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?
References:
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
https://www.sciencedirect.com/science/article/pii/S0933365717306140
https://www.nature.com/articles/s41598-018-31577-1#citeas
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
https://www.jacr.org/article/S1546-1440(17)31661-7/fulltext
Ward
P. Belgian team develops novel way to assess fatigue. AuntMinnieEurope.com 2021;
January 12, 2021
https://www.auntminnieeurope.com/index.aspx?sec=sup&sub=pac&pag=dis&ItemID=619679
https://www.auntminnieeurope.com/index.aspx?sec=sup&sub=wom&pag=dis&ItemID=619432
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