Navigation Links
Tired Doctors More Prone to Errors
Date:10/13/2009

Long shifts, little sleep raise complication rate for practicing physicians, study finds,,

TUESDAY, Oct. 13 (HealthDay News) -- Attending surgeons and obstetricians/gynecologists who get fewer than six hours of sleep between procedures risk increasing the rate of surgical complications, according to Harvard researchers.

A lot of attention has been paid to the long hours that residents and interns work and the increase in medical errors brought on by their fatigue, but the new study found the same problems among practicing physicians.

"Attending surgeons and obstetricians/gynecologists, like resident physicians and nurses, are vulnerable to the effects of fatigue and extended work shifts on performance and patient care," said Dr. Jeffrey M. Rothschild, a physician at Brigham and Women's Hospital in Boston and the lead researcher on the study.

"The risk of performing post-nighttime cases without sufficient rest may be especially important in hospitals without backup support or house staff physicians to assist a fatigued attending physician," he added.

The report is published in the Oct. 14 issue of the Journal of the American Medical Association.

For the study, Rothschild's group assessed how working at night and sleep affected the rate of surgical complications in procedures done the next day. Specifically, they looked at the 919 surgical and 957 obstetrical procedures done the day after a doctor had worked at night and compared them with 3,552 surgical and 3,945 obstetrical procedures done without preceding night work.

When doctors worked overnight but still had sufficient sleep, there was not a significantly increased risk for complications on procedures performed the next day, Rothschild said.

"However, if the opportunity for sleep prior to the post-nighttime procedure was less than six hours, there was a 2.7-fold greater risk of procedural complications, such as infection, wound failure and bleeding," he said. The study also found a higher rate of complications when procedures were performed after a doctor had worked a shift of more than 12 hours, although Rothschild said the rate increase was not statistically significant.

Complications occurred in 5.4 percent of procedures done the day after the doctor had worked at night, compared with 4.9 percent of procedures done without having worked the previous night, the study found.

For doctors who got six or fewer hours of sleep, the complication rate rose to 6.2 percent, compared with 3.4 percent for procedures done by doctors who got more than six hours of sleep. The rate of complications was 6.5 percent for doctors who'd worked more than 12 hours before a procedure, compared with 4.3 percent for those who'd worked fewer than 12 hours.

Rothschild said that attending physicians should consider several approaches to reduce the risks of unsafe levels of fatigue during procedures. These include having large physician groups avoid scheduling elective procedures for doctors who have overnight on-call responsibilities and using hospital-based physicians to cover nighttime emergencies, he said.

"Adequate backup personnel should be available during the day to relieve or assist physicians whose fatigue may impair performance," Rothschild said. "For emergency situations where it is necessary to perform life-saving procedures following overnight work, the appropriate use of caffeine should be considered."

"In addition, attending physicians should try to avoid or cancel or postpone elective procedures if, when following overnight emergency cases, they do not get sufficient rest before the scheduled elective case," he added.

Dr. David A. Lubarsky, a professor, chairman of anesthesiology and senior associate dean for quality safety and risk prevention at the University of Miami Miller School of Medicine, agrees that attending physicians -- not just residents and interns -- should have their hours limited.

"I have eliminated all 24-hour shifts for anesthesiologists," Lubarsky said. "It did increase staffing costs, but I do believe it decreased our error rates."

Lubarsky noted, though, that working long hours is part of the medical culture.

"It takes years of training to get to where you are going to be able to practice," he said. "And people who are unable to function on little sleep -- and there are many -- they just don't make it through the program. You've got to have that level of dedication and intestinal fortitude."

However, Lubarsky said, good doctors are better doctors when they have had enough sleep.

Nonetheless, many doctors believe they can function just as well on little rest.

Doctors are trained to "think they are critical to the care of the patient, and they don't like handing that off," Lubarsky said. "To get where we need to be, we have to get more of a team-based approach to the provision of care. We're just not there yet."

More information

The U.S. Agency for Healthcare Research and Quality has more on improving patient safety.



SOURCES: Jeffrey M. Rothschild, M.D., M.P.H., associate physician, Brigham and Women's Hospital, and instructor, medicine, Harvard Medical School, Boston; David A. Lubarsky, M.D., Emanuel M. Papper professor, chairman, Department of Anesthesiology, Perioperative Medicine and Pain Management, and senior associate dean for quality safety and risk prevention, University of Miami Miller School of Medicine, Miami; Oct. 14, 2009, Journal of the American Medical Association


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Association of Retired Xerox Employees Initiate Legal Proceedings Against Xerox Corporation
2. Tired, Stressed Docs Make More Mistakes, Study Finds
3. Cord Blood America $1.6 Million in Debt Retired in Third Quarter 2009
4. Pay Attention to Signs That Say Youre Too Tired to Drive
5. Retired or Laid Off? Why Not Operate Your Own Business in 2009! Invest in YOU. Become an Entrepreneur!
6. Tired of Sleepless Nights?
7. Mayo clinic: Retired national football league linemen have high incidence of sleep apnea
8. New Dakim Campaign Promotes Brain Fitness for Seniors with Elderly Holding Signs Declaring My Brain Is Not Retired
9. Tired? Sleepless? ... New Sleep Program Good Night, Sleep Right(TM) Launches in April 2009
10. Special Discounts On Fertility Treatment For Active Duty and Retired Military
11. 100 NFL Legends Coming Together in Tampa During Super Bowl Week to Raise Awareness and Funds for Retired Players in Crisis
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/11/2016)... Oregon (PRWEB) , ... February 11, 2016 , ... ... campus participated in the American Osteopathic Association’s (AOA) Match Program Tuesday, February 9, ... Match Program places students into osteopathic graduate medical education positions across the country. ...
(Date:2/11/2016)... ... , ... The Journal of Pain Research has seen a significant ... data taken from the Scopus database (Elsevier B.V.) and is a measure of a ... journal over a three year period and also the importance of the journals where ...
(Date:2/11/2016)... ... February 11, 2016 , ... ... has been gearing up for their simultaneous grand openings in March. All seven ... now that you’re probably wondering, is reversing diabetes possible? According to this 2011 ...
(Date:2/11/2016)... ... 2016 , ... Atlantic Information Services, Inc. (AIS) is pleased ... Study for Plans and Purchasers.” Executives from Intel Corp. and Providence Health & ... health benefits program Connected Care, will discuss the challenges they faced (and how ...
(Date:2/11/2016)... ... 2016 , ... PharmMD CEO Robert Yeager announced ... on contract negotiations, corporate strategy and healthcare data law. Additional responsibilities will include ... data breaches for the Part D Star Rating improvement and Medication Therapy Management ...
Breaking Medicine News(10 mins):
(Date:2/11/2016)... , Feb. 11, 2016 Wearable posture tracker, ALEX , has taken Kickstarter by ... and just seven days left to go, ALEX is said to be delivered to backers starting May ... ... ... Created by ...
(Date:2/11/2016)... Breast Cancer Therapeutics in Asia-Pacific Markets to 2021 ... breast cancer market will experience considerable expansion from $1.9 billion ... Annual Growth Rate (CAGR) of 8.5%. --> Breast ... that the Asia-Pacific (APAC) breast cancer ... to $3.4 billion by 2021, at a Compound Annual Growth ...
(Date:2/11/2016)... , Feb. 11, 2016 PLAD, Inc. (OTC ... 2016 with sales exceeding company targets, are adding key ... their trademark from the United States Patent and Trademark ... , Chief Executive Officer of PLAD, Inc.  In January, ... Pennsylvania with two new customers, Cumberland ...
Breaking Medicine Technology: