Fatigue, Human Factors: Impact on Quality and Preventable Errors

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Fatigue, Human Factors: Impact on Quality and Preventable Errors

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Article by Barger, Ayas, et al – Impact of Extended-Duration Shifts on Medical Errors, Adverse Event

Article by Barger, Ayas, et al, reported the research on long shifts and medical errors. Specifically analyzed was the Impact of Extended-Duration Shifts (>24 hours) on Medical Errors, and preventable Adverse Events by first-year residents (interns). Conclusion: fatigue from long shifts increases the risk of significant medical errors, adverse events, and attention failures by physicians. Data from 2002-2003. Article published at PLoS Medicine, December 2006.

Joint Commission Sentinel Event Alert on Fatigue and Healthcare Workers

Joint Commission’s Sentinel Event Alert on fatigue addresses the impact and risks of healthcare workers’ inadequate sleep and extended work hours on patient care. It is a major hospital workforce concern. Prepared by The Joint Commission, an accrediting body of hospitals and other healthcare organizations, 2011, updated May 2018.

Nurse Fatigue (article by Scott, Rogers, et al)

Learn about Nurse Fatigue in this study of Critical Care nurses. Article by Scott, Rogers, et al, was published in the American Journal of Critical Care, 2006. It led researchers to support the Institute of Medicine recommendations to minimize the use of 12-hour shifts and to limit nurses’ work hours to no more than 12 consecutive hours during a 24-hour period. Title: “Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety”.

Resident Duty Hours – IOM Recommendations

Physician resident duty hours are in a one-page Table of Recommendations (Table S-1, page 13) from the Institute of Medicine (IOM, now known as the National Academies of Medicine). It specifies maximum shift length (16 hours admitting patients), 30-hour shift recommendations, time off between shifts, protected sleep periods of 5 hours, and more. Full report title: Resident Duty Hours: Enhancing Sleep, Supervision, and Safety, published Dec. 2008. A classic report.