Tired Doctors More Prone to Errors

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Complications occurred in 5.4 percent of procedures done the day after the doctor had worked at night, compared with 4.9 percent of procedures done without having worked the previous night, the study found.

For doctors who got six or fewer hours of sleep, the complication rate rose to 6.2 percent, compared with 3.4 percent for procedures done by doctors who got more than six hours of sleep. The rate of complications was 6.5 percent for doctors who'd worked more than 12 hours before a procedure, compared with 4.3 percent for those who'd worked fewer than 12 hours.

Rothschild said that attending physicians should consider several approaches to reduce the risks of unsafe levels of fatigue during procedures. These include having large physician groups avoid scheduling elective procedures for doctors who have overnight on-call responsibilities and using hospital-based physicians to cover nighttime emergencies, he said.

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"Adequate backup personnel should be available during the day to relieve or assist physicians whose fatigue may impair performance," Rothschild said. "For emergency situations where it is necessary to perform life-saving procedures following overnight work, the appropriate use of caffeine should be considered."

"In addition, attending physicians should try to avoid or cancel or postpone elective procedures if, when following overnight emergency cases, they do not get sufficient rest before the scheduled elective case," he added.

Dr. David A. Lubarsky, a professor, chairman of anesthesiology and senior associate dean for quality safety and risk prevention at the University of Miami Miller School of Medicine, agrees that attending physicians -- not just residents and interns -- should have their hours limited.

"I have eliminated all 24-hour shifts for anesthesiologists," Lubarsky said. "It did increase staffing costs, but I do believe it decreased our error rates."

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