What’s New in the Patient Safety World
June 2012
Surgeon Fatigue
In our January 3, 2012 Patient Safety Tip of the Week “Unintended Consequences of Restricted Housestaff Hours” we highlighted a study from Children’s Hospital in Boston (Chua 2011) that found a “night float” system ended up leading to a paradoxical decrease in sleep for residents. Now that same group has published a great study on fatigue in orthopedic residents (McCormick 2012).
Using some tools used in other industries to measure the effects of fatigue they demonstrated that the residents were fatigued almost 50% of their waking time and functioning at an “impaired” level a quarter of the time! Residents wore an actigraphy watch and recorded logs and the study utilized the SAFTE (sleep, activity, fatigue, and task effectiveness) model and Fatigue Avoidance Scheduling Tool for assessment. The average amount of daily sleep per resident was 5.3 hours. According to the tools, they functioned at less than 80% mental effectiveness 48% of the time. More strikingly, they functioned at less than 70% mental effectiveness (equivalent to a blood alcohol level of 0.08%) 27% of their wake time! Numbers for night float residents were even worse. Though they did not actually measure patient outcomes, the tools predicted the overall fatigue levels would increase the risk of medical errors by 22%.
The authors note
that the increased fatigue in the night float system, combined with the issues
related to cross-covering many patients with whom they are less familiar,
results in a situation highly likely to produce many errors.
This is a really
good demonstration on borrowing tools and concepts from other industries and
applying them to critical healthcare situations. Moreover, it’s also a reminder
to always look for unintended consequences when implementing solutions we think
make logical sense. Nice work from solid, practical researchers.
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 2010 “Joint
Commission Sentinel Event Alert: Healthcare Worker Fatigue and Patient Safety
January 3, 2012 “Unintended
Consequences of Restricted Housestaff Hours”
References:
Chua K-P, Gordon MB, Sectish T, Landrigan CP. Effects of a Night-Team System on Resident Sleep and Work Hours. Pediatrics 2011; 128:6 1142-1147
McCormick F, Kadzielski J, Landrigan CP, et al. Surgeon Fatigue. A Prospective Analysis of the Incidence, Risk, and Intervals of Predicted Fatigue-Related Impairment in Residents. Arch Surg 2012; 147(5): 430-435
http://archsurg.jamanetwork.com/article.aspx?articleid=1157932
http://www.patientsafetysolutions.com/
What’s New in the Patient Safety World Archive