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Residents’ Forum: Docs not at par on post-call days

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As good as drunk

As a surgical resident, I have experienced firsthand the “drunk-tired” phenomenon, and to be honest, I do not believe it to be such a rare occurrence. “Drunk-tired” may be eloquently defined as being so tired you start behaving like you’re drunk, without actually consuming any alcohol of course.

The first manuscript relating fatigue amongst shift workers to performance impairment was published in 1996 by Dawson et al. demonstrating that moderate levels of fatigue actually produce more impairment than being legally intoxicated (Nature 1997;388:235). It didn’t take much of a leap to translate these observations to health care workers who work long hours, do shift work, and are on-call at times for more than 24 hours at a time. Recently, at the annual meeting of the American Society of Anesthesiologists in San Diego, Dr. Haleh Saadat from Ohio presented her study on the effects of partial sleep deprivation in staff anaesthesiologists leading to significantly decreased reaction times, cognitive skills, and mood disturbances on post-call days, compared with normal work days. No surprise there, as this is in line with what Dawson and his colleagues published nearly two decades ago. This study can certainly be translated to medical students, residents, fellows and staff from the breadth of specialties in medicine. In my opinion, what’s the point? I can already foresee what these studies are going to demonstrate, namely a clean sweep of all forms of cognitive and motor impairments when a subject is sleep deprived. The question becomes how we are translating all of this information into action that changes the lives of health care professionals and more importantly improves patient safety. Understandably, this is a loaded question and I am simply too exhausted to wrap my head around it.

So, next time you’re post call, feeling irritable, discoordinated, and inhibited, just remember: you’re as good as drunk and you should probably sleep it off.

Dr. Laura Drudi is the resident medical editor for Vascular Specialist.


 

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SAN DIEGO – If you feel sleepy and out of sorts on a post-call day, compared with a normal work-day, you’re not alone.

Anesthesiology faculty reported significant increases in feeling irritable, jittery, and sleepy, along with significant decreases in feeling confident, energetic, and talkative following an on-call period, according to a study presented at the annual meeting of the American Society of Anesthesiologists.

To date, most studies of partial sleep deprivation in health care settings have focused on residents and interns, and less on medical faculty, said lead study author Dr. Haleh Saadat of the department of anesthesiology and pain medicine at Nationwide Children’s Hospital in Columbus, Ohio. “Our call is 17 hours, from 3 p.m. to 7 a.m.; but the call period at most hospitals is 24 hours, and even longer at some private practices,” she said in an interview.

To examine the effects of partial sleep deprivation on reaction time, simple cognitive skills, and mood status in 21 anesthesiologists, Dr. Saadat and her associates obtained verbal consent from the study participants and measured reaction time, mood states, and eight subjective behavioral characteristics at two different time points: between 6:30 a.m. and 8 a.m. on a regular noncall day of work, and between 6:30 a.m. and 8 a.m. after an overnight call (a shift that runs from 3 p.m. to 7 a.m.). The behavioral characteristics included feeling alert, energetic, anxious, confident, irritable, jittery/nervous, sleepy, and talkative, and the researchers used paired t-tests to compare variable means between regular sleep days and post-call days.

Reaction time decreased in all 21 subjects after night call, indicating worse performance (P = .047), while total mood disturbance was significantly higher on post-call days, relative to noncall days (P less than .001).

Of the 21 anesthesiologists, 19 completed all simple cognitive task questions at both time points and reported significant increases in several of these parameters on post-call days, compared with normal work-days.

Post-call observations found participants feeling more irritable, confident, energetic, sleepy (P less than .001), feeling more jittery (P = .003), and feeling less talkative (P less than .001) than on normal work–days.

Coping strategies used to address their sleep deprivation were measured as well, with “most of our subjects using problem solving, followed by seeking social support and avoidance,” Dr. Saadat noted. “People who used avoidance had greater declines in reaction time on post–call days, compared with the rest of the study participants. It didn’t matter whether you were male, female, younger, or older.”

Dr. Saadat called for additional studies to evaluate the neurocognitive impact of partial sleep deprivation on physicians’ on-call duties.

“I would like to see if we can replicate the results in bigger centers,” she said. “If this is what is happening, we may need to pay more attention to faculty’s work hours in both academic and private practice settings – not only among anesthesiologists, but also in other specialties. These observations require a closer look at the potential implications for patients’ and professionals’ safety.”

The researchers reported no financial disclosures.

dbrunk@frontlinemedcom.com

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