NIOSH . NIOSH training for nurses on shift work and long work hours. By Caruso CC, Geiger-Brown J, Takahashi M, Trinkoff A, Nakata A. Cincinnati, OH: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 2015-115 (Revised 10/2021)
Nurse fatigue has been associated with diminished decision-making skills that can contribute to patient harm. This online training program for clinicians and administrators will explore hazards related to nurse fatigue and provide strategies to address behaviors and systems that increase these risks.
Chen Y, Broman AT, Priest G, et al. Jt Comm J Qual Saf. 2021;47:165-175.
Fatigue among health care workers can increase risk of errors. This study posited that blue-enriched light could promote alertness and attention and thereby reduce medical errors in the ICU; however, the authors did not identify any effect of this intervention on error rates.
Fatigue among health care workers can increase the risk of errors. This large cross-sectional study of attending and house staff physicians found that sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Organizational policies should focus on reducing sleep-related impairment in order to reduce harm to patients and physicians.
Donnelly EA, Bradford P, Davis M, et al. CJEM. 2019;21:762-765.
While fatigue has been linked to safety-related outcomes in many healthcare settings, this link has not been definitively established in paramedicine. This article documents preliminary evidence—based on 717 surveys conducted in ten paramedic services in Ontario, Canada—of a relationship between fatigue and paramedic-reported safety outcomes and safety-compromising behaviors. The authors recommend fatigue mitigation efforts.
Physician work hours and fatigue can impact patient safety, particularly among subspecialties focused on high-risk patients. This retrospective cohort study examined outcomes of patients undergoing nonemergent cardiac surgery occurring before or after 3pm. The investigators found no differences in mortality, complications, or length of stay and posit that this may stem from resource availability in these specialized care settings regardless of the time of day.
Brunsberg KA, Landrigan CP, Garcia BM, et al. Acad Med. 2019;94:1150-1156.
Physician burnout and depression are prevalent, costly, and likely to worsen the existing physician shortage. Physicians with depression and burnout also report committing more errors than their peers. Investigators prospectively examined whether pediatric residents reporting depression or burnout were involved in more errors. Participants experiencing depression committed three times as many harmful errors as those without depression. Residents with burnout did not commit more errors or more harmful errors. A strength of this study is that the errors were assessed objectively rather than by self-report. The direction of causality remains unclear—whether physicians with depression commit more harm or committing harm leads to depression. A past PSNet interview discussed how to promote physician satisfaction and well-being.
Taylor-Phillips S, Stinton C. Br J Radiol. 2019;92:20190043.
Physician fatigue is associated with risk of error, but less is known about this issue in radiology care outcomes. This review analyzes the research on this topic and calls for an enhanced examination of how radiologist fatigue directly relates to error. The authors describe study designs that can help further the understanding needed to drive improvement.
Barger LK, Sullivan JP, Blackwell T, et al. Sleep. 2019;42.
In this clustered-randomized trial across six academic medical centers, researchers examined the impact of resident shift duration on hours slept and worked per week during pediatric intensive care unit rotations. They found that residents assigned to extended duration shifts lasting 24 hours or longer worked more hours per week and slept fewer hours per week compared to residents assigned to work shifts lasting 16 hours or shorter.
Bittle MD, Knapp H, Polomano RC, et al. Jt Comm J Qual Patient Saf. 2019;45:337-347.
This report of a quality improvement study of infant drop risk found that mothers who fall asleep holding infants are more likely to drop them. Nursing observations and formal assessments of mothers' sleepiness prevented infant drops from occurring. The authors recommend frequent observation and direct assessment of maternal sleepiness for postpartum wards.
Shapiro DE, Duquette C, Abbott LM, et al. Am J Med. 2019;132:556-563.
Physician burnout is a persistent problem that can have serious effects on safe practice. This review discusses a model to prioritize interventions to address physician burnout. The approach suggests actions at five levels: physical and mental health; safety and security; respect; appreciation and connection; and the ability to fully contribute to care.
Eid SM, Ponor L, Reed DA, et al. J Grad Med Educ. 2019;11:146-155.
Long work hours and fatigue among health care workers can adversely impact patient safety. In 2011, the Accreditation Council for Graduate Medical Education made changes to resident duty hours, but research on the effect of those reforms on resident wellness and patient safety remains somewhat inconclusive. In this retrospective observational study, researchers examined the impact of the 2011 duty hour reforms on patient mortality, length of stay, and cost using data on patients hospitalized in the 2-year periods before and after the work hour changes were implemented. Nonteaching hospitals served as the control group. They found no difference in mortality or length of stay but did find that cost associated with hospitalization decreased slightly at teaching hospitals after the 2011 changes. A past PSNet interview discussed the effect of less restrictive duty hours on patients and residents.
Basner M; Asch DA; Shea JA; Bellini LM; Carlin M; Ecker AJ; Malone SK; Desai SV; Sternberg AL; Tonascia J; Shade DM; Katz JT; Bates DW; Even‑Shoshan O; Silber JH; Small DS; Volpp KG; Mott CG; Coats S; Mollicone DJ; Dinges DF; iCOMPARE Research Group.
This cluster-randomized trial compared an internal medicine residency schedule that adhered to 2011 duty hour regulations to a flexible schedule that maintained an overall 80-hour work week. Self-reported sleepiness and measured sleep duration did not differ by group, but residents in the flexible programs performed worse on psychomotor vigilance testing, a measure of alertness. The authors recommend implementing fatigue-management training during residency.
Gates M, Wingert A, Featherstone R, et al. BMJ Open. 2018;8:e021967.
Fatigue among health care workers is a well-established safety issue that can increase risk of errors. Investigators conducted a systematic review to examine the effects of fatigue on both providers and patients, as well as the impact of efforts designed to mitigate fatigue. They ultimately included 47 studies in their analysis, 28 of which demonstrated a relationship between fatigue or inadequate sleep and physician health outcomes. Looking at six cohort studies and patient outcomes, they found no difference in patient mortality or postoperative complications between surgeons who were and were not sleep deprived. A past PSNet interview discussed how research on sleep deprivation among residents has informed duty hour changes.
Persico N, Maltese F, Ferrigno C, et al. Ann Emerg Med. 2018;72:171-180.
This study team performed cognitive testing on emergency medicine physicians following nights spent at home versus after 14-hour and 24-hour shifts. They did not find any decrement in performance after a 14-hour shift compared to a night of rest. However, physicians' processing speed, working memory, and perceptual reasoning were worse after a 24-hour shift, suggesting that 24-hour shifts for emergency medicine physicians should be limited.
Carthon MB, Hatfield L, Plover C, et al. J Nurs Care Qual. 2019;34:40-46.
This cross-sectional study found that nurses reporting a lower level of engagement also described worse patient safety in their work environment. These concerns were exacerbated when higher patient–nurse staffing ratios were present. The authors suggest that increasing nurse engagement may improve patient safety.
Mossburg SE, Himmelfarb CD. J Patient Saf. 2018;17:e1307-e1319.
Professional burnout is an evolving threat to workforce well-being, health care costs, and patient safety. Leaders of the National Academy of Medicine, Association of American Medical Colleges, and Accreditation Council for Graduate Medical Education recently established a collaborative to promote clinician well-being and resilience. This systematic review explored the relationships between clinician burnout, clinician engagement, organizational safety culture, and patient outcomes. Burnout was consistently associated with self-reported errors. However, when researchers assessed errors objectively, burnout did not reflect an increase in error rates. Few studies have addressed the relationship between burnout and staff engagement or safety culture. An Annual Perspective further explores how to address and prevent health care worker burnout.
Overexposure to clinical alarms can contribute to burnout, errors of omission, and staff fatigue. This guideline suggests improvements for both frontline nurses and nursing leaders to enhance the management of electrocardiogram and pulse oximetry monitoring to reduce false alarms and alarm fatigue.
Clinician burnout can detract from individual wellness, patient safety, and organizational health. This website serves as a companion to a collaborative effort to combat the problem. The site provides research and resources discussing the causes of clinician burnout, its impact on care delivery, and methods available to address factors that contribute to burnout.
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