Fatigue in Anesthesia

Howard, Steven K.; Rosekind, Mark R.; Katz, Jonathan D.; Berry, Arnold J.

doi:10.1097/00000542-200211000-00035

Cited by 136 publications

(29 citation statements)

References 114 publications

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“…Screening colonoscopy by nature can be inherently repetitive and frequently prolonged, characteristics that can promote distractibility and fatigability. Fatigue resulting from repetitive and prolonged activity has already been shown to have a detrimental effect on performance in other medical specialties, such as anesthesia and surgery, as well as in industries such as commercial aviation and trucking (13–17). Further, use of 3-h shifts rather than an entire day’s endoscopy schedule is reported to maintain polyp detection rates constant throughout the day (18), and lack of fatigue with shorter shifts can be argued as a contributor to this.…”

Section: Discussionmentioning

confidence: 99%

Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy

Lee

Iskander

Gupta

et al. 2011

American Journal of Gastroenterology

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OBJECTIVES Endoscopist fatigue potentially impacts colonoscopy. Fatigue is difficult to quantitate, but polyp detection rates between non-fatigued and fatigued time periods could represent a surrogate marker. We assessed whether timing variables impacted polyp detection rates at a busy tertiary care endoscopy suite. METHODS Consecutive patients undergoing colonoscopy were retrospectively identified. Indications, clinical demographics, pre-procedural, and procedural variables were extracted from chart review; colonoscopy findings were determined from the procedure reports. Three separate timing variables were assessed as surrogate markers for endoscopist fatigue: morning vs. afternoon procedures, start times throughout the day, and queue position, a unique variable that takes into account the number of procedures performed before the colonoscopy of interest. Univariate and multivariate analyses were performed to determine whether timing variables and other clinical, pre-procedural, and procedural variables predicted polyp detection. RESULTS During the 4-month study period, 1,083 outpatient colonoscopy procedures (57.5±0.5 years, 59.5% female) were identified, performed by 28 endoscopists (mean 38.7 procedures/endoscopist), with a mean polyp detection rate of 0.851/colonoscopy. At least, one adenoma was detected in 297 procedures (27.4%). A 12.4% reduction in mean detected polyps was detected between morning and afternoon procedures (0.90±0.06 vs. 0.76±0.06, P = 0.15). Using start time on a continuous scale, however, each elapsed hour in the day was associated with a 4.6% reduction in polyp detection (P = 0.005). When queue position was assessed, a 5.4% reduction in polyp detection was noted with each increase in queue position (P = 0.016). These results remained significant when controlled for each individual endoscopist. CONCLUSIONS Polyp detection rates decline as time passes during an endoscopist’s schedule, potentially from endoscopist fatigue. Queue position may be a novel surrogate measure for operator fatigue.

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Section: Discussionmentioning

confidence: 99%

Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy

Lee

Iskander

Gupta

et al. 2011

American Journal of Gastroenterology

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“…[2728] Residents working a traditional “every third night call” schedule were compared to those working a special schedule that eliminated extended work shifts (24 hours more) and reduced the total number of hours worked per week to less than 80 hours. The traditional schedule was associated with 36% more serious medical errors, 21% more serious medication errors and 5.6 times as many serious diagnostic errors compared to the special schedule.…”

Section: Research On Sleep Deprived Residentsmentioning

confidence: 99%

Does our sleep debt affect patients′ safety?

Tewari

Soliz²,

Billota

et al. 2011

Indian J Anaesth

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The provision of anaesthesia requires a high level of knowledge, sound judgement, fast and accurate responses to clinical situations, and the capacity for extended periods of vigilance. With changing expectations and arising medico-legal issues, anaesthesiologists are working round the clock to provide efficient and timely health care services, but little is thought whether the “sleep provider” is having adequate sleep. Decreased performance of motor and cognitive functions in a fatigued anaesthesiologist may result in impaired judgement, late and inadequate responses to clinical changes, poor communication and inadequate record keeping, all of which affect the patient safety, showing without doubt the association of sleep debt to the adverse events and critical incidents. Perhaps it is time that these issues be promptly addressed to prevent the silent perpetuation of a problem that is pertinent to our health and our profession. We endeavour to focus on the evidence that links patient safety to fatigue and sleepiness of health care workers and specifically on anaesthesiologists. The implications of sleep debt are deep on patient safety and strategies to prevent this are the need of the hour.

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“…15 Although research has not proven the effects of fatigue on patient safety, studies have shown that fatigue has a negative impact on alertness, mood, and psychomotor and cognitive performance; all of which can have an impact on patient safety. [21][22][23] Studies of surgical residents suggest that manual dexterity and fine motor skills may be compromised as a result of sleep deprivation. 24 Shift work and, in certain circumstances, long hours and increased workloads are inevitable in patient care.…”

Section: Minimize Fatiguementioning

confidence: 99%

“…Additional recommended strategies from the literature include limiting work hours and on-call periods, using forward rotation of shift work (morning to evening to night shifts), developing workstation environments that minimize distractions from patient care, alertness strategies such as napping and caffeine, and education of physicians and staff about the negative effects of sleep deprivation and fatigue and the importance of good sleep habits. [22][23][24] Immediate accessibility of information at the point of service In order to provide patients with the most accurate diagnosis and treatment possible, physicians need to have complete, ''real-time'' information about the patient, suspected illness, and treatment options. Research has shown that lack of knowledge and information can lead to errors.…”

Section: Minimize Fatiguementioning

confidence: 99%

Safe design of healthcare facilities

Reiling¹

2006

Qual Saf Health Care

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The physical environment has a significant impact on health and safety; however, hospitals have not been designed with the explicit goal of enhancing patient safety through facility design. In April 2002, St Joseph’s Community Hospital of West Bend, a member of SynergyHealth, brought together leaders in healthcare and systems engineering to develop a set of safety-driven facility design recommendations and principles that would guide the design of a new hospital facility focused on patient safety. By introducing safety-driven innovations into the facility design process, environmental designers and healthcare leaders will be able to make significant contributions to patient safety.

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Fatigue in Anesthesia

Cited by 136 publications

References 114 publications

Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy

Queue Position in the Endoscopic Schedule Impacts Effectiveness of Colonoscopy

Does our sleep debt affect patients′ safety?

Safe design of healthcare facilities

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