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Weve done multiple columns on how patient safety is impacted by time of day, day of the week, and month of the year. But Daylight Savings Time?
A study, just presented in abstract form at the SLEEP 2020 meeting, found that adverse events resulting from human errors increased by 18.7% in the week after the Spring time change (Kolla 2020).
The Mayo Clinic researchers began with the premise that the Spring forward change at the start of Daylight Savings Time (DST) which reduces sleep opportunity by an hour, could result in sleep deprivation in healthcare workers and lead to an increase the potential for medical errors. The researchers looked at 8 years of data of self-reported adverse events (AEs) in inpatient, outpatient, and ambulatory settings that occurred 7 days prior to and following the Spring and Fall time changes in a large healthcare organization and identified AEs likely resulting from human error.
They found that adverse events resulting from human errors increased by a statistically significant 18.7% in the week after the Spring time change. A 5% increase in adverse events in the week following the Autumn return to Standard Time from DST was not statistically significant.
The authors conclude there is a significant increase in human error related AEs following the Spring forward clock change which can jeopardize patient safety. They suggest that DST might best be eliminated. Alternatively, they recommend policy makers and healthcare organizations should evaluate measures to mitigate the increased risk during this period.
The study used self-reported AEs in a single healthcare organization and there was no formal measure of actual sleep deprivation. But the findings are fascinating. The authors note their findings need to be replicated in other healthcare organizations.
However, the American Academy of Sleep Medicine on August 26, 2020 issued a position statement that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time (Rishi 2020). It cites an abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. It also states that daylight saving time is less aligned with human circadian biology and that circadian misalignment may be associated in the longer term with increased cardiovascular disease risk, metabolic syndrome and other health risks.
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
Kolla B, Coombes BJ, Morgenthaler TI, Mansukhani MP. 0173 Spring Forward, Fall Back: Increased Patient Safety-Related Adverse Events Following the Spring Time Change. Sleep 2020; 43(Supplement_1): A69
Rishi MA, Ahmed O, Perez JHB, et al. Daylight saving time: an American Academy of Sleep Medicine position statement. Journal of Clinical Sleep Medicine 2020; Published online August 26, 2020
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