Risks of Complications by Attending Physicians After Performing Nighttime Procedures

Rothschild, Jeffrey M.; Keohane, Carol A.; Rogers, Selwyn O.; Gardner, Roxane; Lipsitz, Stuart R.; Salzberg, Claudia; Yu, Tony Fu‐Lai; Yoon, Catherine; Williams, Deborah H.; Wien, Matt F.; Czeisler, Charles A.; Bates, David W.; Landrigan, Christopher P.

doi:10.1001/jama.2009.1423

Cited by 212 publications

(152 citation statements)

References 33 publications

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“…Previous studies, that focused on various surgical procedures, found no association between sleep deprivation and surgical outcomes or complications [28–31]. In contrast to a routine clinical procedure, such as blood drawing, surgical procedures require considerable attention and concentration, which help to overcome the feeling of fatigue and sleepiness due to night duty.…”

Section: Discussionmentioning

confidence: 99%

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Nishida

Kikuchi

Miwakeichi

et al. 2017

Medical Education Online

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Background: Overwork, fatigue, and sleep deprivation due to night duty are likely to be detrimental to the performance of medical residents and can consequently affect patient safety. Objective: The aim of this study was to determine the possibility of deterioration of cerebral function of sleep-deprived, fatigued residents using neuroimaging techniques. Design: Six medical residents were instructed to draw blood from artificial vessels installed on the arm of a normal cooperator. Blood was drawn at a similar time of the day, before and after night duty. To assess sleep conditions during night duty, the participants wore actigraphy units throughout the period of night duty. Changes in cerebral hemodynamics, during the course of drawing blood, were measured using a wearable optical topography system. Results: The visual analogue scale scores after night duty correlated negatively with sleep efficiency during the night duty (ρ = −0.812, p = 0.050). The right prefrontal cortex activity was significantly decreased in the second trial after night duty compared with the first (p = 0.028). The extent of [oxy-Hb] decrease, indicating decreased activity, in the right dorsolateral prefrontal cortex correlated negatively with the Epworth sleepiness score after night duty (ρ = −0.841, p = 0.036). Conclusions: Sleep deprivation and fatigue after night duty, caused a decrease in the activity of the right dorsolateral prefrontal cortex of the residents, even with a relatively easy routine. This result implies that the brain activity of medical residents exposed to stress on night duty, although not substantially sleep-deprived, was impaired after the night duty, even though they apparently performed a simple medical technique appropriately. Reconsideration of the shift assignments of medical residents is strongly advised. Abbreviations: DLPFC: Dorsolateral prefrontal cortex; ESS: Epworth sleepiness scale; PSQI: Pittsburgh sleep quality index; ROI: Regions of interest; VAS: Visual analogue scale; WOT: Wearable optical topography

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Section: Discussionmentioning

confidence: 99%

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Nishida

Kikuchi

Miwakeichi

et al. 2017

Medical Education Online

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“…A retrospective analysis by Benson et al [42], demonstrated significantly lower adenoma detection rates in procedures performed by gastroenterologists who had been "called in" (we assume on-call from home) for emergency procedures the previous night, compared to when procedures were performed by gastroenterologists who had not been on-call the previous night. Another study, not specifically investigating on-call work, found that there were more complications in cases the day after a night with a sleep opportunity of six hours or less compared to when doctors had a sleep opportunity of more than six hours [43]. Although measurement of performance is outside the scope of this review, this research highlights why it is important to understand the sleep and stress of workers operating on-call from home.…”

mentioning

confidence: 87%

The effect of working on-call on stress physiology and sleep: A systematic review

Hall

Ferguson

Turner

et al. 2017

Sleep Medicine Reviews

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SUMMARYOn-call work is becoming an increasingly common work pattern, yet the human impacts of this type of work are not well established. Given the likelihood of calls to occur outside regular work hours, it is important to consider the potential impact of working on-call on stress physiology and sleep. The aims of this review were to collate and evaluate evidence on the effects of working on-call from home on stress physiology and sleep. A systematic search of Ebsco Host, Embase, Web of Science, Scopus and ScienceDirect was conducted. Search terms included: on-call, on call, standby, sleep, cortisol, heart rate, adrenaline, noradrenaline, nor-adrenaline, epinephrine, norepinephrine, nor-epinephrine, salivary alpha amylase and alpha amylase. Eight studies met the inclusion criteria, with only one study investigating the effect of working on-call from home on stress physiology. All eight studies investigated the effect of working on-call from home on sleep. Working on-call from home appears to adversely affect sleep quantity, and in most cases, sleep quality. However, studies did not differentiate between night's on-call from home with and without calls. Data examining the effect of working on-call from home on stress physiology were not sufficient to draw meaningful conclusions. KEYWORDSOn-call; standby; sleep quality; sleep quantity; hypothalamo-pituitary adrenal axis; cortisol; sympatho-adrenal medullary system; sleep. ABBREVIATIONSEPHPP: Effective public health practice project PRISMA: Preferred reporting items for systematic reviews and meta-analyses SD: Standard deviation

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“…[1][2][3][4] Impairments in higher level domains of executive function and decision making have been noted in health care providers who practice during extended and nighttime workshifts. [5][6][7][8] Inadequate sleep increases the risk for errors and near-miss errors in judgment, the use of faulty decision algorithms, and poor patient outcomes. 5,6,8,9 When faced with making decisions about patient care, a nurse may make the wrong decision, leading to adverse patient outcomes and causing decision regret for the nurse.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

“…[5][6][7][8] Inadequate sleep increases the risk for errors and near-miss errors in judgment, the use of faulty decision algorithms, and poor patient outcomes. 5,6,8,9 When faced with making decisions about patient care, a nurse may make the wrong decision, leading to adverse patient outcomes and causing decision regret for the nurse. Decision regret is a negative cognitive emotion that occurs when the actual outcome and the desired or expected outcome differ and reflects concerns that the wrong decision had been made.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses

Scott

Arslanian‐Engoren

Engoren

2014

American Journal of Critical Care

100

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Background The effects of inadequate sleep on clinical decisions may be important for patients in critical care units, who are often more vulnerable than patients in other units. Fatigued nurses are more likely than well-rested nurses to make faulty decisions that lead to decision regret, a negative cognitive emotion that occurs when the actual outcome differs from the desired or expected outcome. Objectives To examine the association between selected sleep variables, impairment due to fatigue, and clinical-decision self-efficacy and regret among critical care nurses. Decision regret was the primary outcome variable. Methods A nonexperimental, descriptive design and extant measures were used to obtain data from a random sample of full-time nurses. Binary logistic regression models were used to examine the association between sleep variables, fatigue, and clinical-decision self-efficacy and regret. The discrimination of the models was compared with the C statistic, the area under the receiver operating characteristic curve. Results A total of 605 nurses returned the questionnaires (17% response rate). Among these, decision regret was reported by 157 of 546 (29%). Nurses with decision regret reported more fatigue, more daytime sleepiness, less intershift recovery, and worse sleep quality than did nurses without decision regret. Being male, working a 12-hour shift, and clinical-decision satisfaction were significantly associated with decision regret (C statistic, 0.719; SE, 0.024). Conclusion Nurses who experience impairments due to fatigue, loss of sleep, and inability to recover between shifts are more likely than unimpaired nurses to report decision regret.

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Risks of Complications by Attending Physicians After Performing Nighttime Procedures

Cited by 212 publications

References 33 publications

Night duty and decreased brain activity of medical residents: a wearable optical topography study

Night duty and decreased brain activity of medical residents: a wearable optical topography study

The effect of working on-call on stress physiology and sleep: A systematic review

Association of Sleep and Fatigue With Decision Regret Among Critical Care Nurses

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