Abnormal sleep may increase nurse errors

U.S. researchers say they found nurses who worked in hospital intensive care units may get less regular sleep than other nurses and may commit more errors.
Researchers at Baylor College of Medicine in Houston assessed the overall sleep quality and vigilance among intensive care unit nurses at the beginning and end of their shift. They compared their findings with similar measurements in floor nurses.
The intensive care nurses and the floor nurses completed the Pittsburgh Sleep Quality Index Questionnaire and were assessed for vigilance at the beginning and end of a 12-hour shift.
The study found the errors at either end of the shift were different only for the nurses who worked in the intensive care unit group, but not on the hospital floors.
The researchers speculated the abnormal sleep and fall in vigilance demonstrated among intensive care unit nurses may have implications for patient safety.
The findings were presented in San Diego at the annual meeting of the American College of Chest Physicians.
(United Press International. November 5th, 2009)

Sleep Deprivation Can Slow Reaction Time

Sleep deprivation can have an enormous impact on your health and happiness. Apparently, it can also affect your ability to make split-second decisions, according to a recent study in the journal SLEEP. Researchers at the University of Texas at Austin split 49 West Point cadets into two groups, 21 of whom were deprived of sleep and 28 of whom were well-rested, and tested them on tasks that require quick decisions. According to the study, participants in each group performed the tasks twice, separated by a 24-hour period. Cadets who were sleep-deprived between testing periods saw their accuracy decline by 2.4 percent, and cadets who were well-rested between testing periods improved by 4.3 percent. W. Todd Maddox, one of the researchers, told HealthDay that the type of thinking tested in this study is "critical in situations when soldiers need to make split-second decisions based about whether a potential target is an enemy soldier, a civilian or one of their own." While people vary in their need for sleep, experts agree that for most adults the amount needed to feel one's best is somewhere between seven and nine hours per night.
(National Sleep Foundation. November 23rd, 2009)


Abstract - Sleep Journal

Work-Hour Limits for Residents — But What About Attendings?

Overnight work by attending physicians with <6 hours of sleep was associated with risk for next-day operative complications.


To limit medical errors, the Institute of Medicine released, and subsequently modified, work-hour recommendations for residents. However, little attention has been paid to work hours of attending physicians who supervise residents.

Researchers conducted a matched retrospective study of obstetrical and surgical procedures at a U.S. urban tertiary care academic center. Procedures were identified as postnighttime procedures if they were performed by attending physicians who had performed additional procedures during the preceding night (midnight–6 AM). A total of 919 surgical and 957 obstetrical postnighttime procedures were matched with 3552 and 3945 control procedures (performed by the same physicians, but not after overnight work), respectively. Complications (e.g., surgical site infections, bleeding, wound failures, organ/visceral injuries) occurred in 101 postnighttime procedures (5.4%) and in 365 control procedures (4.9%). For surgical procedures, when surgeons had limited opportunity for sleep (<6 hours) before postnighttime procedures, complications occurred at a significantly higher rate than when sleep opportunity exceeded 6 hours (8.5% vs. 3.1%).

Comment: These data suggest that sleep deprivation puts patients at risk, regardless of their physicians' level of training. Whether these study results extend to other specialties and nonteaching settings is unclear. Academic institutions have struggled to comply with the work-hour limits for residents, and putting restrictions on schedules of attending physicians would be even more difficult to monitor and enforce. Therefore, we should take action ourselves. Academic centers should press faculty to avoid scheduling elective procedures following overnight call; raising awareness about the effects of sleep deprivation, promoting teamwork, and considering use of surgical nocturnists to cover nighttime on-call responsibilities also would be helpful.

— Neil H. Winawer, MD, FHM (Hospital Medicine - Journal Watch)

Artículo original - JAMA