Effects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance
Effects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance
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DOI：
10.1016/s1553-7250(07)33109-7
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发表时间：
2007-11-01
影响因子：
2.3
通讯作者：
Landrigan, Christopher P.
中科院分区：
文献类型：
--
作者：
Lockley, Steven W.;Barger, Laura K.;Landrigan, Christopher P.
背景：人们越来越关注住院医生和护士的工作时间对患者安全的影响。证据表明，工作时间表对提供者的睡眠和表现以及他们和患者的安全有着深远的影响。轮班时间超过 12.5 小时的护士在工作中警惕性下降、遭受职业伤害或发生医疗错误的风险显着增加。传统的 24 小时待命轮班工作的实习医生遭受职业锐器伤害或下班回家途中遭遇机动车碰撞以及发生严重甚至致命医疗错误的风险大大增加。与 16 小时轮班工作相比，值班住院医师在通宵工作时注意力不集中的情况是前者的两倍，严重的医疗错误也高出 36%。他们还报告说，导致患者死亡的与疲劳相关的医疗错误增加了 300%。结论：大量证据强烈表明，长时间轮班会显着增加疲劳，并损害工作表现和安全性。从提供者和患者的角度来看，美国医疗保健提供者的常规工作时间是不安全的。为了降低医护人员中与疲劳相关的可预防医疗失误和伤害的发生率高得令人难以接受，美国必须制定并执行安全工作时间限制。
Background: There has been increasing interest in the impact of resident-physician and nurse work hours on patient safety. The evidence demonstrates that work schedules have a profound effect on providers' sleep and performance, as well as on their safety and that of their patients. Nurses working shifts greater than 12.5 hours are at significantly increased risk of experiencing decreased vigilance on the job, suffering an occupational injury, or making a medical error. Physicians-in-training working traditional > 24-hour on-call shifts are at greatly increased risk of experiencing an occupational sharps injury or a motor vehicle crash on the drive home from work and of making a serious or even fatal medical error. As compared to when working 16-hours shifts, on-call residents have twice as many attentional failures when working overnight and commit 36% more serious medical errors. They also report making 300% more fatigue-related medical errors that lead to a patient's death.Conclusion: The weight of evidence strongly suggests that extended-duration work shifts significantly increase fatigue and impair performance and safety. From the standpoint of both providers and patients, the hours routinely worked by health care providers in the United States are unsafe. To reduce the unacceptably high rate of preventable fatigue-related medical error and injuries among health care workers, the United States must establish and enforce safe work-hour limits.