A Prevalent Problem: Studies report sleep deprivation in colleagues, patients

Dr. McMillan emphasized the need to educate nurses and administrators about the issues involved in sleep health for nurses and said that otolaryngologists can help these efforts by supporting education and implementation of strategies that prioritize sleep health in general at all levels of health care. “We need to help people understand the wealth of research that exists to support effective strategies, such as light therapy, preemptive naps, nap rooms and the vital need for a nap during break to avoid homeostatic and circadian vulnerability,” she said.

According to Dr. McMillan, current research focusing on the efficacy of napping to reduce problems associated with inadequate sleep shows that this proven strategy to help nurses reduce fatigue-related problems is still met with skepticism among administrators and that, as a result, nurses remain anxious about taking naps during breaks. In her study, only 66 percent of nurses napped during break. “In my view, every unit needs a designated nap room,” she said, “not only for critical care nurses, but every nurse.”

Resident Shifts

Laura Barger, PhD, associate physiologist in the division of sleep medicine at Brigham and Women’s Hospital and instructor in medicine at Harvard Medical School in Boston, reported on a study that looked at the impact of the traditional long work hours of residents in training on motor vehicle crashes, medical errors and adverse events.

Dr. Barger presented the current results as part of a poster titled “Impact of Extended-Duration Shifts on Motor Vehicle Crashes, Medical Errors, and Adverse Events in PGY 2-7 Resident Physicians.”

Using a nationwide web-based survey administered over five years, 13,737 person-months of data were collected from resident physicians in postgraduate years two to seven. In 46 percent of these person-months, the residents reported working 24 hours or more on their longest work shift. The study found a significantly increased risk of motor vehicle crashes or near-miss incidents in residents working long shifts compared to those working shorter shifts, with an odds ratio (OR) of 1.72 (95 percent confidence interval [CI]:1.01-2.90) and 5.13 (95 percent CI: 4.40-5.96), respectively.

As in the nursing study, this study also found a significant increase in medical errors and adverse events associated with fatigue in the health care provider, in this case residents. A significant increase in fatigue-related medical errors was reported by residents who worked months that included one to four extended shifts (OR of 1.77, 95 percent CI:1.01-2.90) or months that included working five or more extended shifts (OR of 5.2, 95% CI:3.79-7.1) compared to months in which they worked no extended shifts.