A paper from the University of Pittsburgh just published in the journal Academic Emergency Medicine claims that emergency medicine docs have problems with short-term memory and sleep after working what seem to be modest shift durations of only 6 to 8 hours.
The study involved 13 ED MDs who were tested before and after both day and night shifts. As is typical of studies in this genre, the tests had nothing to do with what an MD actually does while working but rather were quizzes with names such as the Paced Auditory Serial Addition Test (PASAT), the University of Southern California Repeatable Episodic Memory Test (REMT), the Trail Making Test (TMT), and the Stroop Color-Word Test. Just reading about how these tests are done made me sleep. Never mind having to be subjected to them.
Quality of sleep was assessed by something called the Pittsburgh Sleep Quality Index (PSQI).
Facts that the authors probably did not anticipate would draw a reader’s interest include the following:
The ED docs worked an average of fewer than 10 shifts per month.
7/13 were overweight or obese.
4/13 had at least 4 alcoholic drinks per week.
Like most papers, the abstract does not really reflect all the goodies inside. Table 2 is an elegant massaging of the statistics with 32 different sets of 95% confidence intervals for the memory tests.
The paper notes “Sleep quality was worse in EPs (emergency physicians) compared to the normal population, with 31% of subjects reporting poor sleep quality.” Just in case you forgot, 31% of 13 is 4 people. In the discussion, the authors blamed poor quality sleep on fatigue, which was also quantified. They then made the startling revelation that “sleep disruption continues routinely beyond training years and may be a widespread issue among health care providers.” No kidding?
I have another theory. My experience (based on an “n” of one) is that I often have trouble sleeping when I’m working. I worry about the patients, the decisions I’ve made, whether I checked that lab result, will that clip fall off and lead to bleeding and so on. I think many doctors and nurses have similar thoughts.
But I saved the best for last. Performance on the memory tests was worse for all the ED docs AFTER WORKING BOTH DAY AND NIGHT SHIFTS.
The authors suggested “symptom improvements” might ameliorate these problems. My suggestion, which I blogged about in detail in October of 2010, is to do what the US Navy has successfully done for centuries. That is, have all doctors stand watches of no more than 4 hours at a time. It’s a little inconvenient, but it would reduce fatigue and stress markedly. [Click here to read how it would work.]
I want to thank Andy Neill who blogs at Emergency Medicine Ireland for bringing this paper to my attention.