ACOG Addresses Physician Fatigue And Patient Safety

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Primary Care / General Practice;  Pregnancy / Obstetrics
Article Date: 05 Feb 2008 - 1:00 PDT

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All obstetrician-gynecologists should evaluate the effects that fatigue may have on their ability to care for patients and adjust their workloads, work hours, and time commitments when feasible to avoid fatigue when caring for patients, according to The American College of Obstetricians and Gynecologists (ACOG). In its ongoing commitment to patient safety, ACOG released the new opinion in the February issue of Obstetrics & Gynecology. Although there are few published studies on the effects of fatigue on physicians, there is increasing awareness that fatigue, even partial sleep deprivation, impairs performance.

"It's intuitively obvious that a fatigued physician may not practice as effectively as a well-rested physician, but there are no good data that evaluate practicing ob-gyns," said John S. Wachtel, MD, chair of ACOG's Committee on Patient Safety and Quality Improvement, the committee that produced the document. According to Dr. Wachtel, providing specific guidance to physicians on avoiding fatigue is difficult because there is no objective way to measure fatigue.

The average American adult sleeps only approximately seven hours a night, even though eight hours of sleep per night is the standard recommendation. Physicians, particularly residents and certain specialists that are on call, including ob-gyns, are particularly vulnerable to sleep deprivation. Research demonstrates that even a single night of missed sleep affects cognitive performance. Adults that do not get at least five hours of sleep each night show declines in language and numeric skills, retention of information, short-term memory, and concentration. Studies have also shown that speed of performance may be affected more than accuracy. As an example, surgeons operated more slowly in simulated procedures when sleep deprived, and emergency department physicians took longer to intubate a mannequin.

More research on the effects of fatigue on practicing ob-gyns is needed before specific, evidence-based national guidelines can be developed to improve patient safety and care. In the interim, ACOG believes it is prudent for physicians to consider adapting, when feasible, the sleep guidelines from the National Highway Traffic Safety Administration:

- Structure work to take advantage of circadian influences
- Recognize that the drive to sleep is very strong between 2 am and 9 am, and especially between 3 am and 5 am. Avoid unnecessary work during these times
- Apply good sleep habits which includes a quiet, dark room with adequate ventilation and a comfortable temperature
- After a night shift, go immediately to sleep to maximize sleep length
- Arrange for backup during the time that sleep impairment is likely
- Recognize behavioral changes, such as irritability, that may indicate dangerous levels of fatigue
- Use naps strategically

ACOG advises each practicing physician and every practice group to review their work habits with these principles in mind. Although there may be some negative economic impact of changing schedules to accommodate avoidance of fatigue, patient care and safety must take priority over any economic concerns. Physicians should not fear economic or other penalties for requesting assistance when it comes to taking steps to avoid sleep deprivation.

Committee Opinion #398, "Fatigue and Patient Safety," is published in the February 2008 issue of Obstetrics & Gynecology.

The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.

American College of Obstetricians and Gynecologists

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