Effects of Attending Surgeon and Obstetrician Fatigue on Operating Room Safety

在美国，每年有多达9.8万名患者死于医疗差错。当护士和 研究发现，实习医生睡眠不足会显著增加医疗差错的风险， 关于职业伤害，关于老年人(主治医生)之间的关系的信息很少 医生工作时间和病人安全。在外科和产科，主治医生的工作时间可以 达到或超过正在接受培训的医生的水平。如此长的工作时间是否会降低 然而，经验丰富的主治医生的表现与住院医生一样严重， 未知。有经验的主治医生可能不太容易注意力不集中和表现不佳 比年轻的受训医生清醒时有更强的生理动力入睡 很长时间了。相反，睡眠质量往往会随着年龄的增长而恶化，这可能会导致睡眠时间的增加 债务和与疲劳相关的错误的风险增加。 在之前的一项密集的观察性研究中，我们发现实习医生24小时轮流工作 轮班使严重的医疗错误增加36%，严重诊断错误增加5倍 其计划工作被限制在连续16个小时内。我们建议对以下问题进行深入研究 主治外科医生和产科医生，将衡量手术中的护理过程和错误。正在做 因此，我们将利用我们自己对睡眠和医疗错误进行深入研究的经验，因为 以及量化手术安全性和结果的新兴工具。我们的具体目标是： 1.检验如下假设：技术性能问题的发生率--如预期评估 通过手术中的直接观察以及医疗保健提供者的报告，将显著更高 在手术过程中，过夜病例的第二天(即，病例发生在 凌晨12点和7点)与之前没有任何夜间工作的匹配病例进行比较。 2.检验以下假设：注意力不集中、沟通错误和团队合作的发生率 问题--通过直接的手术中观察以及提供者报告进行前瞻性评估-- 与过夜病例相比，在手术后第二天进行手术的病例将显著更高 在没有任何夜间工作的情况下，白天有匹配的病例。 3.验证术中严重医疗差错(不良事件和 险些失手)--通过直接观察、供应商报告和系统性综合评估 图表监测-在手术后第二天进行的手术病例中，将显著增加 过夜病例与之前没有任何夜班的匹配病例进行比较。 拟议的研究将建立在我们先前关于睡眠剥夺和安全性的研究基础上，以帮助开发 了解跨医学专业和培训水平延长工作时间的影响。

Up to 98,000 patients die each year in the United States due to medical error. While nurse and physician-in-training sleep deprivation has been found to significantly increase the risk of medical errors and occupational injuries, very little information has emerged on the relationship between senior (attending) physician work hours and patient safety. In surgery and obstetrics, the hours of attending physicians can match or exceed those of physicians-in-training. Whether such long work hours might degrade the performance of experienced attending physicians as severely as that of resident-physicians, however, is unknown. Experienced attending physicians may be less prone to attentional failures and performance decrements than younger physicians-in-training who have a stronger physiologic drive to sleep when awake for long hours. Conversely, sleep quality tends to deteriorate with age, which could lead to a buildup of sleep debt and an increased risk of fatigue-related error. In a prior intensive observational study, we found that physicians-in-training working recurrent 24-hour shifts made 36% more serious medical errors and five times as many serious diagnostic errors as those whose scheduled work is limited to 16 consecutive hours. We propose to conduct an intensive study of attending surgeons and obstetricians that will measure intra-operative processes of care and errors. In doing so, we will draw upon both our own experience conducting intensive studies of sleep and medical error, as well as emerging tools to quantify surgical safety and outcomes. Our specific aims will be: 1. To test the hypothesis that the incidence of technical performance problems - as prospectively assessed by direct intra-operative observation, as well as healthcare provider reports - will be significantly higher during surgical cases performed the day following an overnight case (i.e., a case occurring between 12am and 7am) compared with matched cases on days without any preceding night work. 2. To test the hypothesis that the incidence of attentional failures, miscommunications, and teamwork problems - as prospectively assessed by direct intra-operative observation, as well as provider reports - will be significantly higher during surgical cases performed the day following an overnight case compared with matched cases on days without any preceding night work. 3. To test the hypothesis that the incidence of intra-operative serious medical errors (adverse events and near misses) - as assessed by a combination of direct observation, provider reports, and systematic chart surveillance - will be significantly higher during surgical cases performed the day following an overnight case compared with matched cases on days without any preceding night work. The proposed study will build upon our prior studies of sleep deprivation and safety to help develop an understanding of the effects of extended work hours across medical specialties and levels of training.