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






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

















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