Catastrophes, Sleep, and Public Policy: Consensus Report

Mitler, Merrill M.; Carskadon, MA; Czeisler, Charles A.; Dement, William C.; Dinges, David F.; Graeber, R. Curtis

doi:10.1093/sleep/11.1.100

Cited by 750 publications

(333 citation statements)

References 21 publications

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“…108 Increased incidences of single-vehicle car and truck collisions, gas company meterreading errors, and even engineering disasters have been noted to occur at predictable times in the early morning and early afternoon. 109 This research has informed recommendations in EM for eight-or ten-hour shifts, isolated single night shifts or designated long periods of night shifts, clockwise rotation of shifts, and physiologic eating patterns. 110,111 Comparatively little work has been done to look at the process of shift change beyond determining that EPs, when asked, cited erratic schedules and shift changes as stressors in ED work.…”

Section: Automated Drug Dosing and Distributionmentioning

confidence: 97%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

133

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Abstract. An estimated 108,000 people die each year from potentially preventable iatrogenic injury. One in 50 hospitalized patients experiences a preventable adverse event. Up to 3% of these injuries and events take place in emergency departments. With long and detailed training, morbidity and mortality conferences, and an emphasis on practitioner responsibility, medicine has traditionally faced the challenges of medical error and patient safety through an approach focused almost exclusively on individual practitioners. Yet no matter how well trained and how careful health care providers are, individuals will make mistakes because they are human. In general medicine, the study of adverse drug events has led the way to new methods of error detection and error prevention. A combination of chart reviews, incident logs, observation, and peer solicitation has provided a quantitative tool to demonstrate the effectiveness of interventions such as computer order entry and pharmacist order review. In emergency medicine (EM), error detection has focused on subjects of high liability: missed myocardial infarctions, missed appendicitis, and misreading of radiographs. Some system-level efforts in error prevention have focused on teamwork, on strengthening communication between pharmacists and emergency physicians, on automating drug dosing and distribution, and on rationalizing shifts. This article reviews the definitions, detection, and presentation of error in medicine and EM. Based on review of the current literature, recommendations are offered to enhance the likelihood of reduction of error in EM practice.

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Section: Automated Drug Dosing and Distributionmentioning

confidence: 97%

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Schenkel

2000

Academic Emergency Medicine

133

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“…These problems alone or in combination are cumulative for up to a week and beyond (Van Dongen et al, 2003). A 'sleep debt' is incurred which results in cognitive and performance deficits, particularly during the overnight and midday circadian peaks of sleep pressure (Mitler et al, 1988).…”

Section: Sleep Lossmentioning

confidence: 99%

“…Drowsiness is known to be a major factor in automobile crashes (Mitler, 1988) reviewed in (George, 2004), with the incidence of crashes over the day being coincident with the expected nadirs in circadian rhythm (Garbarino et al, 2001;Horne and Reyner, 1995;Mitler, 1988). Even minor amounts of sleep deprivation may impair simulated driving performance (Arnedt et al, 2001).…”

Section: Sleep Lossmentioning

confidence: 99%

“…Even minor amounts of sleep deprivation may impair simulated driving performance (Arnedt et al, 2001). Work errors have been related to sleep deprivation and shift work (Akerstedt, 1988;Mitler, 1988;Mitler et al, 1997;Akerstedt, 1987, 1988a). There are documented negative effects of sleep loss and shift work on medical professionals (Cavallo et al, 2002;Friedman, 2004;Steele et al, 1999).…”

Section: Sleep Lossmentioning

confidence: 99%

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Vigilance, alertness, or sustained attention: physiological basis and measurement

Oken

Salinsky

Elsas

2006

Clinical Neurophysiology

660

463

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Vigilance is a term with varied definitions but the most common usage is sustained attention or tonic alertness. This usage of vigilance implies both the degree of arousal on the sleep-wake axis and the level of cognitive performance. There are many interacting neural and neurotransmitter systems that affect vigilance. Most studies of vigilance have relied on states where the sleep-wake state is altered, e.g. drowsiness, sleep-deprivation, and CNS-active drugs, but there are factors ranging from psychophysics to motivation that may impact vigilance. While EEG is the most commonly studied physiologic measure of vigilance, various measures of eye movement and of autonomic nervous system activity have also been used. This review paper discusses the underlying neural basis of vigilance and its assessment using physiologic tools. Since, assessment of vigilance requires assessment of cognitive function this aspect is also discussed.

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“…Night workers commonly experience high levels of sleep loss and sleepiness (Å kerstedt, 1998; Å kerstedt et al, 2002), which can potentially lead to cumulative performance degradation (Belenkey et al, 2003;Dinges et al, 1997;Van Dongen et al, 2003) and increased accident risk (Å kerstedt et al, 2002;Dinges, 1995;Mitler et al, 1988). Short naps are frequently recommended as a strategy to minimise these effects (Å kerstedt, 2006;Bonneford et al, 2004;Schweitzer et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Scheduled napping as a countermeasure to sleepiness in air traffic controllers

Signal

Gander

Anderson³

et al. 2009

Journal of Sleep Research

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SUMMAR Y The aims of this study were to measure sleep during a planned nap on the night shift;and to use objective measures of performance and alertness to compare the effects of the nap opportunity versus staying awake. Twenty-eight air traffic controllers (mean age 36 years, nine women) completed four night shifts (two with early starts and two with late starts). Each type of night shift (early ⁄ late start) included a 40-min planned nap opportunity on one occasion and no nap on the other. Polysomnographic data were used to measure sleep and waking alertness [spectral power in the electroencephalogram (EEG) during the last hour of the night shift and the occurrence of slow rolling eye movements (SEMs) subsequent to the nap]. Psychomotor performance task [Psychomotor Vigilance Task (PVT)] was completed at the beginning and end of the shift, and after the nap (or an equivalent time if no nap was taken). Nap sleep latencies were relatively long (mean = 19 min) and total sleep time short (mean = 18 min), with minimal slow wave sleep (SWS, mean = 0%), and no rapid eye movement sleep. Nap sleep resulted in improved PVT performance (mean and slowest 10% of reaction time events), decreased spectral power in the EEG and reduced the likelihood of SEMs. The occurrence of SWS in the nap decreased spectral power in the EEG. This study indicates that although sleep taken at work is likely to be short and of poor quality it still results in an improvement in objective measures of alertness and performance.k e y w o r d s air traffic control, naps, neurophysiological alertness, night shift, psychomotor performance, within-subjects field study

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Catastrophes, Sleep, and Public Policy: Consensus Report

Cited by 750 publications

References 21 publications

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Promoting Patient Safety and Preventing Medical Error in Emergency Departments

Vigilance, alertness, or sustained attention: physiological basis and measurement

Scheduled napping as a countermeasure to sleepiness in air traffic controllers

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