Additional Statement on Medical Errors

National Summit on Medical Errors and Patient Safety Research

American Academy of Sleep Medicine

The Impact of Sleep Loss in Housestaff on Medical Error

Additional Statement, Submitted by Sigrid C. Veasey, M.D., American Academy of Sleep Medicine, National Institutes of Health (NIH) Sleep Academic Awardee

The first National Summit on Medical Errors and Patient Safety Research was held on September 11, 2000, in Washington, DC. Sponsored by the Quality Interagency Coordination Task Force (QuIC), the Summit’s goal was to review the information needs of individuals involved in reducing medical errors and improving patient safety. More importantly, the summit set a coordinated and usable research agenda for the future to answer these identified needs.

Selected applicants testified at the summit as members of the witness panels. The remainder of the applicants were invited to submit additional statements for consideration by the steering committee. One of these statements follows.

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It is intriguing that while many professions involving high stakes for human error have studied the effects of sleep loss on workers’ performances and on accident rates and are providing counter-measures for the effects of sleep loss, this is less true for the medical profession, where many would consider the stakes highest. Furthermore, over the past twenty-five years, more than 50 small studies have shown neurobehavioral performance impairments in housestaff following one night on-call or one night of sleep loss. Specifically, neurobehavioral tests for vigilance and cognition, and performance tests such as placing an intubation tube for mechanical ventilation, interpreting electrocardiograms and placing a central venous catheter have repeatedly shown decrements in housestaff performance after one night of reduced sleep (e.g., 1-3). Another way of investigating this issue is to ask doctors to what do they attribute their serious mistakes (4). The most frequently cited reason was "tiredness," accounting for over half of the serious mistakes. Thus, sleep loss is likely to be an important contributor to medical error. To date, however, there are many unanswered questions that must be addressed to help reduce this contributor to medical error:

How large a factor is sleep loss in housestaff and practicing physicians for medical error?
To what classes of medical errors does sleep loss in physicians contribute?
Are there predictors for these types of medical errors?

Are certain individuals more vulnerable to the neurobehavioral consequences of sleep loss?
Is there a circadian variance to medical error (times of day when medical error is greatest)?
Are there specific medical activities during which loss of vigilance is more likely to occur and result in error (mundane repeated tasks compared to surgery or emergency activities)?

Are there effective counter-measures to reduce medical error from sleep loss?

Is caffeine ingestion effective in reducing medical error?
Will administration of Modafanil (central stimulant) to housestaff post-call reduce error?
Are there schedules that can be employed to reduce medical errors?
Would short enforced naps or education on sleep loss effects increase sleep time and reduce error rates?

1. Lingenfelser T., et al. 1994. Young hospital doctors after night-duty: their task specific status and emotional condition. Med Educ 28:566-72.

2. Samkoff JS, et al. 1991. A review of studies concerning effects of sleep deprivation and fatigue on residents performance. Academ Med 66:687-93.

3. Nelson CS, et al. 1995. Residents' performance before and after night call as evaluated as evaluated by an indicator of creative thought. J Am Osteopath Assn 95: 600-3.

4. Firth-Cozens J, et al. 1997. Doctors' perceptions of the links between stress and lowered clinical care. Soc Sci Med 44: 1017-22.

Current as of September 2000

Internet Citation:

American Academy of Sleep Medicine. Additional Statement. National Summit on Medical Errors and Patient Safety Research. September 2000. http://www.quic.gov/summit/asleep.htm

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