Effects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance

被引:265
作者
Lockley, Steven W. [1 ,2 ]
Barger, Laura K. [1 ,2 ]
Ayas, Najib T. [3 ]
Rothschild, Jeffrey M. [4 ]
Czeisler, Charles A. [1 ,5 ]
Landrigan, Christopher P. [6 ,7 ,8 ]
机构
[1] Brigham & Womens Hosp, Dept Med, Div Sleep Med, 75 Francis St, Boston, MA 02115 USA
[2] Harvard Med Sch, Div Sleep Med, Boston, MA USA
[3] Univ British Columbia, Med, Vancouver, BC, Canada
[4] Harvard Med Sch, Med, Boston, MA USA
[5] Harvard Med Sch, Sleep Med, Boston, MA USA
[6] Brigham & Womens Hosp, Dept Med, Sleep & Patient Safety Program, Div Sleep Med, Boston, MA 02115 USA
[7] Childrens Hosp Boston, Inpatient Pediat Serv, Dept Med, Boston, MA USA
[8] Harvard Med Sch, Pediat & Med, Boston, MA USA
基金
美国医疗保健研究与质量局; 美国国家航空航天局;
关键词
D O I
10.1016/S1553-7250(07)33109-7
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:7 / 18
页数:12
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