Sleep Deprivation and Patient Safety

January 30, 2011

According to the Society of Actuaries, medical mistakes cost the U.S. economy over $19.5 billion in 2008. During that year, the report estimates that medical mistakes caused over 1.5 million injuries, resulting in 2,500 estimated deaths. Though the causes for mistakes vary, doctor fatigue has often been cited as a major factor in medical errors.

In a recent study published in the New England Journal of Medicine (NEJM), the authors cite studies which show an increased risk of complications for patients who undergo elective procedures performed by a sleep-deprived doctor. Specifically, the study noted an 83 percent chance of complications when the surgeon has had less than a six-hour opportunity for sleep between procedures during a previous on-call night.

The authors question whether surgeons should be required to disclose their sleeplessness to patients and let the patient decide whether to continue with the procedure. As a first step, the report advises hospitals to implement policies which reduce the opportunity for sleep deprivation, including more structured shift changes.

The authors also recommend that patients be able to ask their doctor how much sleep they have had before undergoing elective procedures. They endorse the model proposed by the Sleep Research Society which makes it mandatory for doctors who have been awake 22 of the past 24 hours to "inform their patients of the extent and potential safety impact of their sleep deprivation and to obtain consent from such patients prior to providing clinical care or performing any medical or surgical procedures."

Critics Cite the Need for More Training, Not Disclosure

But critics disagree with the author's assessment and note that the proper way to avoid fatigue related errors is to better train doctors and surgeons about the effects that sleep deprivation can have on their bodies and performance.

In a reply letter written by doctors with the American College of Surgeons, the doctors note that even if more control was given to the patient and doctors were required to disclose the amount of sleep that does little to address the root cause of the problem, namely a "lack of awareness about our human limitations." Further, the critics argue that each case is unique and a lack of sleep may not be a factor for relatively simple surgeries, but may be an issue in more complex procedures.

The NEJM authors, however, note that the lack of sleep impairs a person's ability to recognize the effect that sleeplessness has on the individual. Therefore, surgeons who are sleep deprived are "not likely to assess accurately the risks posed when they perform procedures in such a state."

A Prior Push for Change

A 2008 report by the Institute of Medicine previously called for a change in the way doctors are trained. Residents often work long hours in emergency room settings, making them more prone to errors as they are not only working on lack of sleep, but also learning the practice of medicine. Specifically, the report called for changes in how residents are scheduled, including mandatory sleep breaks and structured shift changes, which reduce the likelihood of errors due to fatigue.

The IOM's recommendations did not include a reduction in overall work hours, rather a shift in how those hours are worked. The report, summarized in The New York Times, concludes that no resident should work more than 16 hours straight and that should be followed by a required five hour sleep break. Other recommendations include:

- Better supervision of residents
- Prohibitions against moonlighting or working extra jobs
- Mandatory days off each month
- Assigning remedial duties to other hospital workers giving residents more time to focus on patients

The NEJM study notes that the Accreditation Council for Graduate Medical Education revised its recommendations concerning residents' work hours. According to the ACGME, residents in their first postgraduate year should work, at most, 16 consecutive hours followed by a minimum of 8 hours off duty.

Working With an Attorney

Medical and surgical errors can have serious and even fatal consequences. If you have been injured by any act of malpractice, it is important to discuss your case with an experienced personal injury.

Article provided by Knapp & Roberts
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