Thursday, 19 June 2014

Do doctors need more sleep?

A recent study has found that shorter shifts for doctors may improve patient care and prevent human error due to fatigue. Co authored by SPHPM's PhD candidate Dev Kevat, the article suggests that an increasing weight of evidence is demonstrating that sleep deprivation and circadian rhythm disruption in doctors are associated with human error and harm to both patients and doctors.

According to the study, the amount of sleep required to function optimally is relatively consistent across the population. Increased sleep debt (due to chronic sleep deficiency) has been observed in individuals who claim to require less sleep than that recommended for the broader population. Studies in healthy volunteers have demonstrated that reducing the opportunity to sleep from 8 hours to 6 hours per night resulted in significant impairments in attention and cognitive performance; restriction to 4 hours resulted in even greater deficits. Participants were inaccurate in estimating their sleepiness levels, particularly when the deficits accumulated over several days — a concern in the hospital setting. A randomised prospective intervention study that eliminated extended work and on-call shifts of 24 hours or more resulted in increased sleep duration for junior doctors, along with reduced sleepiness and attention failures during wake time. 22% more serious errors were made by the control group compared with the intervention group.

The paper notes that while most Australian jurisdictions do not roster doctors for shifts longer than 16 hours, long shifts followed by an on-call period are common. On-call periods may be a legal loophole to continued work and are a patient safety blind spot. Across weekends in particular, many trainee doctors are likely to be working at levels of sleep deprivation that place them at high risk of making errors that cause patient harm.

Click here to read the full study. 

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