regional medical center: Some Surgical Residents Not Well Rested

Rabu, 23 Mei 2012

Some Surgical Residents Not Well Rested

Some Surgical Residents Not Well Rested

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Main Category: Public Health
Also Included In: Sleep / Sleep Disorders / Insomnia
Article Date: 23 May 2012 - 14:00 PDT

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The May edition of JAMA's Archives of Surgery reports that surgical residents are often exhausted during their awake-time. The study reports that medical errors are a worldwide problem, with increasing numbers of publications suggesting that fatigue could be a considerable contributing factor for medical errors.

Frank McCormick, M.D., from the Harvard Combined Orthopedic Residency Program and Massachusetts General Hospital and his team decided to assess the sleeping and awake periods of 27 surgical residents by continuously recording their patterns with an actigraphy, a device that is worn like a wristwatch, which records and stores sleeping and awake-time data to evaluate individual mental fatigue.

According to the results, the participants slept on average 5.3 hours per day, whilst residents' individual average sleep ranged from 2.8 to 7.2 hours. Overall, fatigue resulted in a mental effectiveness of less than 80% during an average 48% of awake-time amongst residents. The impact of fatigue also demonstrated a reduced functioning of less than 70% mental effectiveness during an average 27% of the residents' time awake.

The study also revealed that working night shifts produced higher levels of fatigue than day shifts, with residents on night shifts sleeping an average of 5.1 hours per day, whilst those on day shift have a daily average of 5.7 hours of sleep.

The researchers reached the conclusion that: "resident fatigue was prevalent, pervasive, and variable."

Invited Critique: Surgical Fatigue - What Dreams May Come

Thomas F. Tracy Jr., M.S., M.D., of Hasbro Children's Hospital and Brown University, Providence, R.I., declares in an invited comment:

"There is a lot to like in this study by McCormick and colleagues ... Their actual determination of fatigue during certain periods is not startling, but its pervasiveness is a finding we simply cannot avoid and may have paid lip service to in the past. It is unlikely that the data in this study will be refuted. Tested cognitive errors that occur in judgment or performance during fatigue infer medical error or the potential for it. Unfortunately, we have few examples of direct specific correlations from large-scale cause or high-fidelity systems failure analysis that clearly define the fatigue-harm axis across surgical services."

He concludes, writing: "From this and other studies, it seems we have made things worse by our attempt to fill mandates of prescribed work hours on the basis of activities external to health care delivery systems. If we are really serious about this, it may be time to debate work hours and methods in training centers to mitigate patient error with the inclusion of these measurements to adequately design shift configuration."

Written By Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Additional

References

Citations

"A Prospective Analysis of the Incidence, Risk, and Intervals of Predicted Fatigue-Related Impairment in Residents"
Frank McCormick, MD; John Kadzielski, MD; Christopher P. Landrigan, MD, MPH; Brady Evans, BS; James H. Herndon, MD, MBA and Harry E. Rubash MD
Archives of Surgery , May 2012, doi: 10.1001/archsurg.2012.84 Please use one of the following formats to cite this article in your essay, paper or report:

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regional medical center

Rabu, 23 Mei 2012

Some Surgical Residents Not Well Rested

Invited Critique: Surgical Fatigue - What Dreams May Come

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