The effects of fatigue on physician performance - an underestimated cause of physician impairment and increased patient risk

Parker, John B.

doi:10.1007/bf03014356

Cited by 38 publications

(20 citation statements)

References 48 publications

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“…The detrimental effects of sleep deprivation on physician and EMS personnel performance and mood have been well documented. [29][30][31][32][33][34] Melatonin has been used in the treatment of sleep disorders, insomnia, and jet lag for many years. 2,4,5,14,15,28,35 Side effects are minimal, rare, and similar to those of placebo controls.…”

Section: Discussionmentioning

confidence: 99%

Effect of Exogenous Melatonin on Mood and Sleep Efficiency in Emergency Medicine Residents Working Night Shifts

Jockovich

Cosentino

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: To determine whether melatonin taken prior to attempted daytime sleep sessions will improve daytime sleep quality, nighttime sleepiness, and mood state in emergency medicine (EM) residents, changing from daytime to nighttime work schedules. Methods: A prospective, randomized, double-blind crossover design was used in an urban emergency department. Emergency medicine residents who worked two strings of nights, of at least three nights' duration each, and separated by at least one week of days were eligible. Subjects were randomized to receive either melatonin 1 mg or placebo, 30 to 60 minutes prior to their daytime sleep session, for three consecutive days after each night shift. Crossover to the other agent occurred during their subsequent night shifts. Objective measures of quality of daytime sleep were obtained using the Actigraph 1000. This device measures sleep motion and correlates with sleep efficiency, total sleep time, time in bed, and sleep latency. The Profile of Mood States (POMS) and the Stanford Sleepiness Scale (SSS) were also used to quantify nighttime mood and sleepiness. Results: Among the 19 volunteers studied, there was no difference in sleep efficiency (91.16% vs 90.98%, NS), sleep duration (379.6 min vs 342.7 min, NS), or sleep latency (7.59 min vs 6.80 min, NS), between melatonin and placebo, respectively. In addition, neither the POMS total mood disturbance (5.769 baseline vs 12.212 melatonin vs 5.585 placebo, NS) nor the SSS (1.8846 baseline vs 2.2571 melatonin vs 2.1282 placebo, NS) demonstrated a statistical difference in nighttime mood and sleepiness between melatonin and placebo. Conclusions: There are no beneficial effects of a 1-mg melatonin dose on sleep quality, alertness, or mood state during night shift work among EM residents. Key words: melatonin; mood; sleep efficiency; night shifts; emergency medicine residents. ACADEMIC EMERGENCY MEDICINE 2000; 7:955-958 The need to change from day to night shifts on a regular basis can make it difficult for emergency physicians (EPs) to maintain normal cir-

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Section: Discussionmentioning

confidence: 99%

Effect of Exogenous Melatonin on Mood and Sleep Efficiency in Emergency Medicine Residents Working Night Shifts

Jockovich

Cosentino

et al. 2000

Academic Emergency Medicine

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“…[4849] More than 50% of anesthesia care providers admitted having committed an error in medical judgment that they attributed to fatigue in studies by Gaba[50] and Gravenstein. [51] Utilizing the critical incident method of evaluating anesthetic errors, Cooper et al .…”

Section: Introductionmentioning

confidence: 99%

The fatigued anesthesiologist: A threat to patient safety?

Sinha

Singh

Tewari

2013

J Anaesthesiol Clin Pharmacol

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Universally, anesthesiologists are expected to be knowledgeable, astutely responding to clinical challenges while maintaining a prolonged vigilance for administration of safe anesthesia and critical care. A fatigued anesthesiologist is the consequence of cumulative acuity, manifesting as decreased motor and cognitive powers. This results in impaired judgement, late and inadequate responses to clinical changes, poor communication and inadequate record keeping. With rising expectations and increased medico-legal claims, anesthesiologists work round the clock to provide efficient and timely services, but are the "sleep provider" in a sleep debt them self? Is it the right time to promptly address these issues so that we prevent silent perpetuation of problems pertinent to anesthesiologist’s health and the profession. The implications of sleep debt on patient safety are profound and preventive strategies are quintessential. Anesthesiology governing bodies must ensure requisite laws to prevent the adverse outcomes of sleep debt before patient care is compromised.

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“…References from any period on this subject are few [1]. Dr Price mentions the 'bad old days' of 72 h weekends.…”

Section: Sleep Deprivation and Performancementioning

confidence: 99%

“…Aspiration and testing of the contents from blindly inserted feeding tubes is a useful method of detection. In a study by Neumann et al, aspiration of contents was successful in 85% of patients and a pH < 4 was very accurate in predicting a correct tube position [1]. By testing for pH and enzyme (trypsin and pepsin) concentrations to differentiate between respiratory and gastrointestinal placement, 100% of respiratory and 93.4% of enterally placed feeding tubes were correctly classified by Metheny et al [2].…”

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confidence: 99%