Effects of Attending Surgeon and Obstetrician Fatigue on Operating Room Safety

主治外科医生和产科医生疲劳对手术室安全的影响

• 批准号: 7790550
• 负责人: Charles A Czeisler
• 金额: $ 44.5万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-04-01 至 2013-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7790550
• 关键词: Academic Medical Centers; Address; Adverse event; Age; Aging; Aging-Related Process; Automobile Driving; Biological; Blood alcohol level measurement; Caring; Cause of Death; Cessation of life; Circadian Rhythms; Clinical; Cognition; Communication; Communities; Community Hospitals; Complex; Data Collection; Deterioration; Diagnostic Errors; Discipline of Nursing; Discipline of obstetrics; Educational Status; Elderly; Environment; Failure; Fatigue; Gynecologist; Gynecology; Hand; Health Personnel; Healthcare; Home environment; Hospitals; Hour; Human; Incidence; Injury; Institute of Medicine (U.S.); Knowledge; Lead; Measurement; Measures; Medical; Medical Errors; Methodology; Napping; Needlestick Injuries; Nurses; Observational Study; Obstetric Surgical Procedures; Occupational; Operating Rooms; Operative Surgical Procedures; Outcome; Patient Care; Patients; Performance; Phase; Physicians; Physiological; Plant Roots; Play; Prevalence; Process; Provider; Recommendation; Recurrence; Relative (related person); Reporting; Research; Rest; Risk; Role; Safety; Schedule; Sharps Injury; Sleep; Sleep Apnea Syndromes; Sleep Deprivation; Sleep Disorders; Sleeplessness; Societies; Surgeon; Techniques; Testing; Time; Training; United States; Vehicle crash; Work; awake; base; community setting; coping; experience; hazard; injured; medical specialties; member; operation; patient safety; pressure; prospective; public health relevance; shift work; tool; young adult

DESCRIPTION (provided by applicant): 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. Public Health Relevance: Between 44,000 and 98,000 patients die each year in the United States due to medical error. We have previously found that the traditional long work hours of physicians-in-training greatly increase their risk of making medical errors, but there remains considerable debate in the medical community about whether experienced physicians' performance deteriorates with sleep deprivation. We plan to conduct an intensive study in the operating room using established direct observational techniques and measurement tools to determine if sleep deprivation increases senior surgeons' and obstetricians' risk of error.

描述（由申请人提供）：由于医疗错误，美国每年最多98,000名患者死亡。尽管发现护士和培训睡眠剥夺的护士会大大增加医疗错误和职业伤害的风险，但关于高级（参加）医师工作时间与患者安全之间关系的信息很少。在手术和妇产科中，主治医生的时间可以匹配或超过训练医生的时间。但是，如此漫长的工作时间是否会像居民一样严重地降低经验丰富的医生的表现，但是尚不清楚。与年轻的训练医生相比，经验丰富的主治医生可能不容易受到注意力失败和表现的降低，而年轻的训练医生长时间醒着睡眠的生理动力更强。相反，睡眠质量往往随着年龄的增长而恶化，这可能导致睡眠债务增加，并增加与疲劳有关的错误风险。在先前的一项密集的观察性研究中，我们发现，进行培训的医师经常发生的24小时轮班造成36％的严重医疗错误和五倍的严重诊断错误，其预定工作限制为连续16个小时。我们建议对主管医生和产科医生进行深入的研究，以衡量术中护理和错误过程。通过这样做，我们将借鉴自己对睡眠和医疗错误进行深入研究的经验，以及量化手术安全性和结果的新兴工具。我们的具体目的是：1。要测试以下假设：技术性能问题的发生率（如直接的术中观察结果以及医疗保健提供者的报告所预期的评估 - 在过夜病例后进行的外科手术案例在外科手术案例中将显着更高（即，与没有任何预先夜间工作相比，与匹配的案例相比，与匹配的案例相比，在夜间案件中发生的情况（即，在凌晨12点和7点之间发生）。 2。为了检验以下假设：注意力失败，误解和团队合作问题的发生率（通过直接的术中观察结果以及提供者的报告对前瞻性评估）将在隔夜病例后进行过夜间案例的外科手术案例在隔夜病例后进行的，而没有任何前几天的夜间工作。 3。为了检验以下假设：通过直接观察的组合，提供者报告和系统的图表监视的组合评估，术中严重的严重医疗误差（不良事件和接近遗漏）的发生率将在手术案例中与隔夜病例相比，在没有任何先前的夜间工作的情况下进行过夜案例，在手术案例中会显着更高。拟议的研究将基于我们先前关于睡眠剥夺和安全性的研究，以帮助了解医学专业和培训水平的延长工作时间的影响。公共卫生相关性：由于医疗错误，美国每年有44,000至98,000名患者死亡。我们以前已经发现，接受培训的传统工作时间大大增加了他们犯医疗错误的风险，但是医学界仍然有很多关于经验丰富的医师的绩效是否随着睡眠剥夺恶化的争论。我们计划使用既定的直接观察技术和测量工具在手术室进行一项密集研究，以确定睡眠剥夺是否会增加高级外科医生和产科医生的错误风险。