Real‐time fatigue reduction in emergency care clinicians: The SleepTrackTXT randomized trial

Patterson, P. Daniel; Buysse, Daniel J.; Weaver, Matthew D.; Doman, Jack; Moore, Charity G.; Suffoletto, Brian; McManigle, Kyle L.; Callaway, Clifton W.; Yealy, Donald M.

doi:10.1002/ajim.22503

Cited by 20 publications

(41 citation statements)

References 66 publications

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“…One intrashift intervention used text messages to perform momentary assessments of EMS workers while they were on-shift. Interventional messages were sent if employees reported severe fatigue, sleepiness or difficulty with concentration 36. Participants were highly compliant, and the intervention reduced fatigue and sleepiness in a subgroup of participants.…”

Section: Discussionmentioning

confidence: 99%

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

et al. 2015

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Objectives Emergency medical services (EMS) clinicians are shift workers deployed in two-person teams. Extended shift duration, workplace fatigue, poor sleep, and lack of familiarity with teammates are common in the EMS workforce and may contribute to workplace injury. We sought to examine the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors. Methods We obtained three years of shift schedules and occupational injury and illness reports were from 14 large EMS agencies. We abstracted shift length and additional scheduling and team characteristics from shift schedules. We matched occupational injury and illness reports to shift records and used hierarchical logistic regression models to test the relationship between shift length and occupational injury and illness while controlling for teammate familiarity. Results The cohort contained 966,082 shifts, 4,382 employees, and 950 outcome reports. Risk of occupational injury and illness was lower for shifts ≤8 hours in duration (RR 0.70; 95% CI 0.51–0.96) compared to shifts >8 & ≤12 hours. Relative to shifts >8 & ≤12 hours, risk of injury was 60% greater (RR 1.60; 95% CI 1.22–2.10) for employees that worked shifts >16 and ≤24 hours. Conclusions Shift length is associated with increased risk of occupational injury and illness in this sample of EMS shift workers.

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Section: Discussionmentioning

confidence: 99%

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

et al. 2015

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“…The logistical challenges associated with PVT measurement of a mobile workforce like air‐medical clinicians are significant. Deficits in performance among EMS clinicians are believed to occur during the mid‐point to end of shifts that last greater than 12 h—specifically between midnight and 0500 . Future investigations should design their protocol to include multiple measures of PVT performance, yet weigh the cost versus benefits when determining the total number of measurements per shift.…”

Section: Discussionmentioning

confidence: 99%

“…The basis for allowing multiple participations and limiting total participations to two include: (1) our pool of potentially eligible participants was limited to four study sites and (2) minimal information would be gained with more than two participations by any one individual under the same shift duration. Our calculation was based on the following assumptions: (1) complete start and end of shift PVT data from each participant for at least one shift during the study period and (2) a 20% rate of attrition across study sites, which is of a similar level observed in previous research . Findings are presented in tables stratified by the number of times a participant had participated in this study (once or twice).…”

Section: Methodsmentioning

confidence: 99%

Impact of shift duration on alertness among air‐medical emergency care clinician shift workers

Patterson

Weaver

Markosyan

et al. 2019

American J Industrial Med

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Background: Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. We sought to compare the alertness level of EMS shift workers by shift duration. Methods:We used a multi-site, 14-day prospective observational cohort study design of EMS clinician shift workers at four air-medical EMS organizations. The primary outcome was behavioral alertness as measured by psychomotor vigilance tests (PVT) at the start and end of shifts. We stratified shifts by duration (< 24 h and 24 h), night versus day, and examined the impact of intra-shift napping on PVT performance. Results:One hundred and twelve individuals participated. The distribution of shifts <24 h and 24 h with complete data were 54% and 46%, respectively. We detected no differences in PVT performance measures stratified by shift duration (P > 0.05). Performance for selected PVT measures (lapses and false starts) was worse on nightInstitution at which the work was performed: The University of Pittsburgh served as the coordinating center and one of four study sites. Other sites included: Mercy Flight based in Buffalo, NY; MedCenter Air based in Charlotte, NC; and MedFlight of Ohio based in Columbus, Ohio. SUPPORTING INFORMATIONAdditional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Patterson PD, Weaver MD, Markosyan MA, et al. Impact of shift duration on alertness among air-medical emergency care clinician shift workers.

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“…This is the second study of its kind to use mobile phone text messages as a vehicle to conduct real-time assessment and intervention of a unique clinician population [7, 9]. …”

Section: Discussionmentioning

confidence: 99%

“…2) [7, 9]. We have added additional single-item assessments to occur between scheduled shifts (inter-shift).…”

Section: Methodsmentioning

confidence: 99%

Fatigue mitigation with SleepTrackTXT2 in air medical emergency care systems: study protocol for a randomized controlled trial

Patterson

Moore

Guyette

et al. 2017

Trials

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BackgroundMost air medical Emergency Medical Services (EMS) clinicians work extended duration shifts, and more than 50% report inadequate sleep, poor sleep quality, and/or poor recovery between shifts. The SleepTrackTXT pilot trial (ClinicalTrials.gov, NCT02063737) showed that use of mobile phone text messages could impact EMS clinician self-reported fatigue and sleepiness during long duration shifts. The purpose of the SleepTrackTXT2 trial is to leverage lessons learned from the first SleepTrackTXT study and test an enhanced intervention targeting air medical EMS clinicians.Methods/designWe will conduct a multi-site randomized trial with a sample of adult EMS clinicians recruited from four air medical EMS systems located in the midwest, northeastern, and southern USA. Participants will be allocated to one of two possible arms for a 4-month (120-day) study period. The intervention arm will involve text-message assessments of sleepiness, fatigue, and difficulty concentrating at the beginning, every 4 hours during, and at the end of scheduled shifts. Participants reporting high levels of sleepiness, fatigue, or difficulty with concentration will receive one of nine randomly selected intervention messages to promote behavior change during shift work to improve alertness. Intervention participants will receive a text-message report on Friday of each week that shows their sleep debt over the previous 7 days followed by a text message to promote paying back sleep debt recovery when feasible. Participants in the control group receive text messages that only include assessments. Both arms will receive text-message assessments of perceived recovery since last shift, sleepiness, fatigue, or difficulty with concentration at noon (1200 hours) on days between scheduled shifts (off-duty days). We have two aims for this study: (1) to determine the short-term impact of the enhanced SleepTrackTXT2 intervention on air medical clinician fatigue reported in real time during and at the end of shift work, and (2) to determine the long-term impact of the SleepTrackTXT2 intervention on sleep quality and sleep health indicators including hours of sleep and recovery between shift work.DiscussionThe SleepTrackTXT2 trial may provide evidence of real-world effectiveness that would support widespread expansion of fatigue mitigation interventions in emergency care clinician shift workers. The trial may specifically support use of real-time assessments and interventions delivered via mobile technology such as text messaging.Trial registrationClinicalTrials.gov, NCT02783027. Registered on 23 May 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1999-z) contains supplementary material, which is available to authorized users.

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Real‐time fatigue reduction in emergency care clinicians: The SleepTrackTXT randomized trial

Cited by 20 publications

References 66 publications

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers

Impact of shift duration on alertness among air‐medical emergency care clinician shift workers

Fatigue mitigation with SleepTrackTXT2 in air medical emergency care systems: study protocol for a randomized controlled trial

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