Does simulator-based clinical performance correlate with actual hospital behavior? The effect of extended work hours on patient care provided by medical interns

Details

• Personal Author:
  Alexander EK ; Czeisler, Charles A. ; Flynn-Evans E ; Gordon JA ; Landrigan CP ; Lockley SW ; Venkatan SK
• Corporate Authors:
  Harvard Medical School. Harvard Work Hours Health and Safety Group
• Description:
  PURPOSE: The correlation between simulator-based medical performance and real-world behavior remains unclear. This study explored whether the effects of extended work hours on clinical performance, as reported in prior hospital-based studies, could be observed in a simulator-based testing environment. METHOD: Intern volunteers reported to the simulator laboratory in a rested state and again in a sleep-deprived state (after a traditional 24- to 30-hour overnight shift [n=17]). A subset also presented after a shortened overnight shift (16 scheduled hours [n=8]). During each laboratory visit, participants managed two critically ill patients. An on-site physician scored each case, as did a blinded rater later watching videotapes of the performances (score=1 [worst] to 8 [best]; average of both cases=session score). RESULTS: Among all participants, the average simulator session score was 6.0 (95% CI: 5.6-6.4) in the rested state and declined to 5.0 (95% CI: 4.6-5.4) after the traditional overnight shift (P<.001). Among those who completed the shortened overnight shift, the average postshift simulator session score was 5.8 (95% CI: 5.0-6.6) compared with 4.3 (95% CI: 3.8-4.9) after a traditional extended shift (P<.001). CONCLUSIONS: In a clinical simulation test, medical interns performed significantly better after working a shortened overnight shift compared with a traditional extended shift. These findings are consistent with real-time hospital studies using the same shift schedule. Such an independent correlation not only confirms the detrimental impact of extended work hours on medical performance but also supports the validity of simulation as a clinical performance assessment tool. [Description provided by NIOSH]
• Subjects:
  Circadian Rhythm Delivery Of Health Care Environmental Monitoring Fatigue Hazardous Substances Health Care Facilities Workforce And Services Health Personnel Laboratories Occupational Health Safety Shift Work Schedule Sleep Sleep Initiation And Maintenance Disorders Surveys And Questionnaires Workplace

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• Keywords:
  Circadian-rhythms Exposure-assessment Exposure-levels Exposure-methods Health-hazards Laboratory-testing Medical-care Medical-facilities Medical-personnel Medical-services Medical-surveys Physiological-effects Physiological-fatigue Physiological-response Shift-work Shift-workers Sleep-deprivation Statistical-analysis Work-analysis Work-environment Work-operations Work-performance Work-practices Workplace-studies

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• ISSN:
  1040-2446
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; OSHA Region 1
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  85
• Issue:
  10
• NIOSHTIC Number:
  nn:20037753
• Citation:
  Acad Med 2010 Oct; 85(10):1583-1588
• Contact Point Address:
  Dr. Gordon, Division of Medical Simulation, Department of Emergency Medicine, Massachusetts General Hospital, Zero Emerson Place, Suite 3B, Boston, MA 02114
• Email:
  jgordon3@partners.org
• Federal Fiscal Year:
  2011
• Performing Organization:
  Brigham and Women's Hospital
• Peer Reviewed:
  True
• Start Date:
  20010930
• Source Full Name:
  Academic Medicine: Journal of the Association of American Medical Colleges
• End Date:
  20060929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:814d49a1596d148bb8e3026a7aa96e49ea10618604eaec8b3de61c211760f21d4b68d3904e7912b40aea9e1f5c20c377793fe92cc4026d01df7522c1f9f61f86
• Download URL:
  https://stacks.cdc.gov/view/cdc/191739/cdc_191739_DS1.pdf
• File Type:
  [PDF - 410.73 KB ]