Association between shift work and cognitive performance on the Trail Making Test in emergency department health officers

Abstract

Objective: Shift work has been proposed to disturb alertness and decrease cognitive efficiency. However, studies so far have had varied findings. The aim of the present study was to compare cognitive function following shifts at different times of the day in an Australian ED context. Methods: A prospective, selfcontrolled observational study was conducted on medical and nursing staff at a tertiary referral centre and regional hospital ED. Participants were required to complete the Trail Making Test (TMT), a neurocognitive test consisting of two parts (TMT-A and TMT-B), at baseline (at the start of the day) and at the end of their shift (day, evening or night). Related samples Wilcoxon signed-rank tests were used to compare post-shift TMT performance to baseline in medical and nursing staff. Results: Over a 5-month period, 140 ED staff were recruited including 109 doctors and 31 nurses. After a night shift, medical staff (n = 85) and nursing staff (n = 29) took longer to complete the TMT-B by 3.4 s (P < 0.001) and 7.1 s (P = 0.01), respectively, compared to baseline. Post-evening shift, medical staff (n = 59) took longer to complete the TMT-A by 0.3 s (P = 0.02). Conclusions: Night shift work was associated with a longer TMT time. This may indicate a decrease in cognitive performance, in particular, visual attention, processing speed, task switching and executive function and may implicate the quality of care for patients and worker safety.

Occupation-Induced Fatigue and Impacts on Emergency First Responders: A Systematic Review

“…In addition, PVT scores continued to decline in line with wildland firefighters' deployment length [56]. The findings of this review align with the current literature where cognitive fatigue reduces reaction time [16,106,107] and alertness [13]. Proper cognitive functioning can be negatively altered after just one night of sleep loss [32].…”

The effects of work on cognitive functions: a systematic review

“…Among 64 studies included in the systematic review, 39 were related to the effect of shift work on cognitive functions ( Table 4 ) ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Smith et al, 1995 ; Petru et al, 2005 ; Rouch et al, 2005 ; Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Chang et al, 2011 , 2013a , b ; Anderson et al, 2012 ; Shwetha and Sudhakar, 2012 , 2014 ; Niu et al, 2013 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Kazemi et al, 2016 , 2018 ; Maltese et al, 2016 ; Titova et al, 2016 ; Vajravelu et al, 2016 ; Haidarimoghadam et al, 2017 ; Soares and de Almondes, 2017 ; Williams et al, 2017 ; Persico et al, 2018 ; Taylor et al, 2019 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Athar et al, 2020 ; James et al, 2021 ; Prasad et al, 2021 ; Stout et al, 2021 ; Sun et al, 2021 ; Zhao et al, 2021 ; An et al, 2022 ; Benítez-Provedo et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ).…”

“… Stout et al (2021) sought to determine the impact of shift work on cognitive functions in firefighters and reported that even minimal sleep disruption, caused by night shift, affected cognitive functioning, increasing risk of poor work performance or injury. Sun et al (2021) compared cognitive functions among different work shifts in an emergency department and found night shift work to be associated with a decrease in cognitive performance. Taylor et al (2019) compared cognitive performance and vigilance at the start and end of each work shift within a three-shift schedule in police forces; the results showed a significant main effect of shift type in visuo-spatial task.…”

“…Many studies focused their attention on the negative effects of shift work on circadian rhythm ( Schettini et al, 2023 ) and consequently on sleep and cognitive functions. Particularly, most studies highlighted detrimental effects: such among healthcare workers, medical professionals, as anaesthesiologists had a decline in reaction time, problem-solving, attention, and mental flexibility after night shift ( Saricaoğlu et al, 2005 ; Griffiths et al, 2006 ; Williams et al, 2017 ; Abdelhamid et al, 2020 ; Adams and Venter, 2020 ; Prasad et al, 2021 ), nurses had affected reaction time, motor ability, attention, cognitive flexibility, working memory, and decision making after work shift ( Chang et al, 2011 , 2013a , b ; Niu et al, 2013 ; James et al, 2021 ; Sun et al, 2021 ; An et al, 2022 ; Esmaily et al, 2022 ; Peng et al, 2022 ), other categories of physicians(intensivists, emergency doctors, gynaecologists, junior doctors, hospital doctors, medical house officers, postgraduate year one physicians) had a deficit in attention, executive function, memory, motor function, and reaction time after night shift ( Deary and Tait, 1987 ; Orton and Gruzelier, 1989 ; Lingenfelser et al, 1994 ; Anderson et al, 2012 ; Özdemir et al, 2013 ; Veddeng et al, 2014 ; Maltese et al, 2016 ; Persico et al, 2018 ; Benítez-Provedo et al, 2022 ). Other workers, such as security staff ( Vajravelu et al, 2016 ; Athar et al, 2020 ), control room operators ( Kazemi et al, 2016 , 2018 ; Haidarimoghadam et al, 2017 ), business process outsourcing employees ( Shwetha and Sudhakar, 2012 , 2014 ), power plant workers ( Smith et al, 1995 ), petrochemical workers ( Soares and de Almondes, 2017 ), firefighters ( Stout et al, 2021 ), police employees ( Taylor et al, 2019 ), miners ( Zhao et al, 2021 ), and generic groups of workers ( Rouch et al, 2005 ; Titova et al, 2016 ) had an impairment in one or more cognitive functions.…”

Night Physician–Nurse Collaboration: Developing the Scale of Physicians’ Difficulties and Exploring Related Factors in Acute Care Hospitals

“…In addition, the impact of night shifts on cognitive performance may also affect the process of shared situation awareness for both physicians and nurses. A recent study assessing the cognitive performance of clinicians after each shift suggested that cognitive performance worsens for both physicians and nurses after night shifts 46 The cognitive impact during the night shift may affect the ability of nurses to organize and convey information and of physicians to be aware of the situation based on reports from the nurse. Domain 2 (Barriers to working with nurses) represented the content of perceiving difficulties in working with nurses due to a lack of support or nurses' attitudes and usual relationships when managing patients with clinical deterioration.…”