Fatigue-related adverse events that injured a patient also significantly increased with monthly shifts that included one to four extended shifts (OR of 2.53, 95 percent CI:1.02-6.25) or five or more extended shifts (OR of 3.36, 95% CI:1.52-7.41) compared to months with no extended shifts.
Explore This IssueJuly 2011
“Work-hour reform is needed that eliminates extended-duration shifts for all residents,” said Dr. Barger, who said that residents other than first-year residents are still allowed to work extended hours despite new guidelines by the Accreditation Council for Graduate Medical Education that, when implemented on July 1, 2011, newly mandate the reduction of work shifts for first-year residents to a maximum of 16 hours.
Scope of the Problem
Outside the health care system, inadequate sleep and sleep disorders are major problems that also need better recognition and reporting to improve health outcomes. Jon-Erik C. Holty, MD, MS, staff pulmonologist at the Palo Alto VA Health Care System, presented a study that looked at the relationship of sleep complaints and health care utilization in 2,183 randomly selected adult U.S. residents participating in the National Health and Nutrition Examination Survey (NHANES) from 2005-2006. Dr. Holty presented his research as part of a poster titled “Patients with sleep complaints utilize more healthcare: an analysis of NHANES.”
The study found that although 99 percent of adults reported at least one sleep-related complaint that occurred five or more times per month, and most reported four or more concomitant complaints, only 24 percent had reported their sleep problems to a health care provider. These sleep complaints included nonrestorative sleep (56 percent), not enough sleep (54 percent), snoring (46 percent), daytime sleepiness (45 percent), waking too early (44 percent) and trouble falling asleep (37 percent).
In the respondents who did receive a medical evaluation for non-sleep problems such as diabetes and arthritis, these problems were associated with their sleep complaints. Of these, 37 percent of respondents were deemed at risk for insomnia and 33 percent for sleep apnea, but only 1 percent and 5 percent, respectively, had a prior diagnosis.
The study found that people who did report sleep problems had a significantly higher use of health care resources, including health care visits, overnight hospitalizations and evaluation by a mental health provider, as well as higher rates of work absenteeism.
These results underscore the need for health care providers to routinely assess the presence of sleep complaints and disorders in their patients, Dr. Holty said.