Joint Commission Sentinel Event Alert -- Sleepiness

The Joint Commission published a short article last month on sleep deprivation and it's effects on patient (and provider) safety.  There are a lot of issues at play here and changing the culture of how we learn and practice medicine isn't quite as simple as saying, "Let's work fewer hours."  Though to guide our discussions, it is useful to understand what has been presented in the literature.

A selection (quoting from the Joint Commission article -- full sources can be found in the article) from a 2007 article in the Joint Commission Journal on Quality and Patient Safety:

"The article reports that residents who work traditional schedules with recurrent 24-hour shifts:

- make 36% more serious preventable adverse events than individuals who work no more than 16 consecutive hours
- make 5 times as many serious diagnostic errors
- have twice as many on-the-job attentional failures at night
- experience 61 % more needlestick and other sharp injuries after their 20th consecutive hour of work
- experience a 1.5 to 2 standard deviation deterioration in performance relative to baseline rested performance on both clinical and non-clinical tasks
- report making 300% more fatigue related preventable adverse events that led to a patient’s death"

Lockley SW, et al: Effects of health care provider work hours and sleep deprivation on safety and performance. The Joint Commission Journal on Quality and Patient Safety, November 2007;33(11)7-18, http://www.jointcommission.org/JQPS_11_07/