Medical residents working within the mandated maximum of 80 hours per week experience severe sleepiness, a finding that may have implications for both patient care and resident safety, according to a new study.
Previous studies have shown that sleep-deprived residents perform poorly in several areas like judgment and concentration and are at risk for motor vehicle accidents. There have been several instances where sleep-deprived residents have committed serious mistakes in patient care. This led the ACGME (Accreditation Council for Graduate Medical Education), in 2003, to limit their work hours to not more than 80 hours a week and 24 hours at a stretch. The impact of this standard has not been well studied.
"We need to be aware that, though residents are working within guidelines, they are reporting to work for a 24-hour shift already sleepy and, on post-call, exhibit sleepiness in the pathologic range. This degree of sleepiness is seen in medical conditions such as obstructive sleep apnea and narcolepsy. This has the potential to impact decisions about patient care, especially on a post-call day and has a bearing on their safety in driving home," says lead researcher Shyam Subramanian, M.D., Director of Sleep Services at the Baylor College of Medicine in Houston.
To find out how the work schedule affects residents, the researchers studied 20 residents the day before and the day after they were on-call for 24 hours at the hospital's Intensive Care Unit (ICU). The objective sleepiness was assessed using a test called Multiple Sleep Latency Test (MSLT). In this test, the residents rest comfortably with their eyes closed in a dark room for 20 minutes and their brain activity is continuously recorded. The test is based on the idea that the sleepier a person is, the faster he or she will fall asleep. To assess subjective sleepiness, each resident was given a "sleepiness score." The residents' sleepiness scores were significantly abnormal on the post-call day.
The residents were also given a battery of psychometric tests pre- and post-call to measure concentration, attention, reaction time and motor coordination. In one test, they were given a grid with 400 letters and they had to cross out the letters A, N, E and Y in three minutes. In testing reaction times, the residents pushed a button every time they saw a shape appear on the computer screen.
"There were no significant changes in these tests between the pre- and post-call days. This may be because they performed poorly to begin with on the pre-call day or possibly there was a learning curve on a post-call day," says co-author Raghu Reddy, M.D., who is presenting the findings at the ATS meeting. "In future we plan to study the influence of sleepiness in the post-call residents on their ability to manage real-time simulations of patient care and incidence of medical errors."
This research was presented at the American Thoracic Society 2007 International Conference, on Sunday, May 20. "Assessment of Sleepiness in Post Call Medical ICU Residents" (Session A30; Abstract # 4856; Poster Board E7)
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