Sleep deprivation is a major factor for clinical errors

A study of clinical errors made by resident physicians in a teaching hospital reveals that the more tired they are the more mistakes they make. The study published in the International Journal of Behavioural and Healthcare Research puts figures to this seemingly obvious conclusion and shows that fewer errors are made if clinical practices are standardised. The research could help promote the case for improved working conditions for junior doctors in order to improve patient outcomes.

Zvi Stern of the Hadassah Hebrew University Medical Center in Jerusalem, Israel, and colleagues report that resident physicians, colloquially known as "residents" are the frontline providers of the majority of in-patient medical care in teaching hospitals. The work is stressful, has often overwhelming responsibilities, and involves working long hours with little opportunity for adequate sleep and recuperation. Previous research has shown that sleep deprivation due to long working hours is a major factor in clinical errors made by residents.

The Harvard Work Hours, Health and Safety Study presented the most rigorous proof that fatigue causes medical errors and led to the US Accreditation Council for graduate medical education limiting residents' working hours. However, this has been criticised more recently in light of the fact that even with reduced hours errors made by residents remain a major problem in many teaching hospitals.

Now, Stern and colleagues have analysed the results from error reports by senior nurses, who had been working closely with 126 resident physicians at two teaching hospitals. The team suggested that standardisation of the residents' work processes through the use of strict procedures and guidelines could reduce the number of errors they make, particularly when tired.

Standardisation sets out the precise guidelines, options and examinations that a resident needs to complete when treating patients, Stern explains, this should have the effect of averting treatment lapses and slip-ups because procedures and methodologies are written out and checklists are used.

"Standardisation does not allow the shortcuts or confusion that fatigue might produce because it prevents residents from concentrating on one option only," Stern explains, "It forces residents to work 'by the book' and follow predetermined treatment options."

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