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The Human Cost of 24/7/365

January 27, 2023

Written by Vivian Lei

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Emergency physicians (EPs) suffer from poor sleep quality and lower sleep quantity than recommended. EPs were also objectively more fatigued during late afternoon and evening shifts and spend almost a quarter of their shift in a fatigued state. 

Why does this matter?
Shift workers are susceptible to fatigue and its related risks. EPs often have complex and varied shift schedules, but objective measurements of fatigue have not been well-studied.

The human cost of 24/7/365
In this small study of 17 EPs at an academic medical center, participants wore a Readiband, which is a commercially available wrist-worn movement tracking device that provides sleep metrics and predicted fatigue scores. Data was collected over 2 months, for an average of 23 shifts per physician (range 10-41 shifts). The average sleep quality score was 7.71/10 (optimal range <6) and sleep quantity was 6.77 hours (optimal range 7-9 hours). A calculated hourly fatigue score, or Readiscore, was assessed as a function of the preceding sleep metrics based upon the validated Sleep, Activity, Fatigue, and Task Effectiveness (SAFTE) model. Across all participants, 50.6% of the work period was spent in a high-performance state with Readiscores >90, while 23.5% of the work period was spent with Readiscores <80, which corresponds with increased risk of error due to fatigue. When Readiscores were plotted against shift start time, they found that Readiscores increased for shift start times between 6 AM and 2 PM, but then decreased from 2 PM to 11 PM.

This was essentially a pilot study to assess whether a specific method of measuring EP sleep quantity, sleep quality, and predicted fatigue was feasible. Further validation of the fatigue prediction model in clinicians is necessary before it can be applied toward investigating risk-reduction interventions.

Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2022 Oct 14. doi: 10.1111/acem.14606. Epub ahead of print.

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