医学
活动记录
骨科手术
心理干预
物理疗法
睡眠(系统调用)
前瞻性队列研究
急诊医学
物理医学与康复
外科
内科学
昼夜节律
精神科
计算机科学
操作系统
作者
Frank McCormick,John Kadzielski,Christopher P. Landrigan,Brady T. Evans,James H. Herndon,Harry E. Rubash
出处
期刊:Archives of Surgery
[American Medical Association]
日期:2012-05-01
卷期号:147 (5)
被引量:112
标识
DOI:10.1001/archsurg.2012.84
摘要
Hypothesis
A novel approach to identify at-risk periods among orthopedic surgical residents may direct fatigue risk mitigation and facilitate targeted interventions.Design
A prospective cohort study with a minimum 2-week continuous assessment period. Data on sleep and awake periods were processed using the sleep, activity, fatigue, and task effectiveness model.Setting
Rotations at 2 academic tertiary care centers.Participants
Twenty-seven of 33 volunteer orthopedic surgical residents (82%) completed the study, representing 65% (33 of 51) of the orthopedic residency program.Intervention
Residents' sleep and awake periods were continuously recorded via actigraphy, and a daily questionnaire was used to analyze mental fatigue.Main Outcome Measures
Percentage of time at less than 80% mental effectiveness (correlating with an increased risk of error), percentage of time at less than 70% mental effectiveness (correlating with a blood alcohol level of 0.08%), the mean amount of daily sleep, and the relative risk of medical error compared with chance.Results
Residents were fatigued during 48% and impaired during 27% of their time awake. Among all residents, the mean amount of daily sleep was 5.3 hours. Overall, residents' fatigue levels were predicted to increase the risk of medical error by 22% compared with well-rested historical control subjects. Night-float residents were more impaired (P = .02), with an increased risk of medical error (P = .045).Conclusions
Resident fatigue is prevalent, pervasive, and variable. To guide targeted interventions, fatigue modeling can be conducted in hospitals to identify periods, rotations, and individuals at risk of medical error.
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