A study from the U.S. of doctors in their first postgraduate year (interns) has showed that working extended shifts is associated with increased reporting by the doctors of medical errors, adverse patient events and attentional failures.
The study, published in PLoS Medicine, which was led by Charles Czeisler and Laura Barger from Brigham and Women's Hospital and Harvard Medical School, included 2737 medical residents, who completed 17,003 monthly reports. In months in which residents worked even one long shift-of 24 hours or more -they were three times more likely to report a fatigue-related significant medical error compared with months in which they worked no extended hours. The rate increased to more than -seven-fold higher in months in which more than five extended shifts were worked.
These errors apparently translated into adverse patient events; even in the months in which residents worked one extended shift they were seven times more likely to report an adverse patient event compared with months when no extended shift was worked. In addition, doctors working more than five extended duration shifts per month reported more attentional failures, (i.e., dozing off) during lectures, during ward rounds and during clinical activities, including surgery, and reported 300 percent more fatigue-related preventable adverse events resulting in the death of the patient.
A recent randomized controlled trial in critical care units showed that the elimination of extended duration work shifts reduced the rates of significant medical and attentional failures in that setting. This new study shows that extended duration shifts worked by a diverse population of interns across the U.S. are also associated with reporting of medical errors, adverse events and attentional failures.
The authors conclude that "These results have important public policy implications for post-graduate medical education."
A Perspective article by Mariana Szklo-Coxe, from the University of Wisconsin, who was not involved in the study, discusses the findings further.
Citation: Barger LK, Ayas NT, Cade BE, Cronin JW, Rosner B, et al. (2006) Impact of extended-duration shifts on medical errors, adverse events, and attentional failures. PLoS Med 3(12): e487. (http://dx.doi.org/10.1371/journal.pmed.0030487)
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