title: The impact of a single 24 h working day on cognitive and psychomotor performance in staff anaesthesiologists.
abstract: OBJECTIVE
  The profession of anaesthesiologist is demanding and potentially hazardous. Extended work shifts combined with intensive work load may adversely affect physicians' performance. The aim of this study was to explore the impact of a single in-hospital 24 h shift on the cognitive and psychomotor performance of anaesthesiologists in a surgical emergency department.
  
  
  METHODS
  Following ethical and institutional approval, 11 staff anaesthesiologists [six men, five women, age 48 (35-50), years of experience 17 (7-20), median (range)] successfully completed the study protocol. Four computer-generated psychological tests (CRD, Complex Reactionmeter Drenovac, Croatia) consisting of light signal position discrimination (CRD 311), simple visual orientation (CRD 21), simple arithmetic operations (CRD 11), and complex psychomotor coordination (CRD 411) were used to measure objective parameters of cognitive and psychomotor performance at four time points (D1 = 8:00 a.m., D2 = 3:00 p.m., D3 = 11:00 p.m.; and D4 = 7:00-8:00 a.m. next day) during the 24 h working day. The control testing on an ordinary working day was performed at two time points (C1 = 8:00 a.m., C2 = 3:00 p.m.). Three parameters were recorded: total test solving time (TTST), total variability, and total number of errors for all four tests.
  
  
  RESULTS
  TTST was significantly impaired during the 24 h shift in all tests, and TTST was prolonged in CRD 21 test at different time points from 1.6 +/- 1.4 to 5.5 +/- 1.6 s compared with the control (F = 6.39, P = 0.001). The reaction times were prolonged from 1.3 +/- 1.8 to 5.4 +/- 1.2 s (F = 3.49, P = 0.009) in CRD 311, from 3.8 +/- 9.0 to 34.3 +/- 5.8 s (F = 5.05, P = 0.002) in CRD 11 TTST, and from 0.8 +/- 3.0 to 16.3 +/- 8.6 s (F = 2.67, P = 0.034) in CRD 411. Total variability was significantly altered during the 24 h shift only in CRD 411 (F = 2.63, P = 0.036). There was no difference in the total number of errors between the 24 h shift and the ordinary working day.
  
  
  CONCLUSIONS
  Anaesthesiologists' 24 h working day in the emergency department altered cognitive and psychomotor function in comparison with ordinary working days. Speed, reliability and mental endurance (measured by TTST) were significantly impaired in all four tests. Stability and reaction time (measured by total variability) were only slightly impaired. Paradoxically, attention and alertness (measured by total number of errors) were not adversely affected. In conclusion, anaesthesiologists' psychomotor performance was impaired during the single 24 h shift.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital Split, Croatia.
authors.forename: Nenad
authors.initials: N
authors.lastname: Karanovic
authors.forename: Mladen
authors.initials: M
authors.lastname: Carev
authors.forename: Goran
authors.initials: G
authors.lastname: Kardum
authors.forename: Renata
authors.initials: R
authors.lastname: Pecotic
authors.forename: Maja
authors.initials: M
authors.lastname: Valic
authors.forename: Sandra
authors.initials: S
authors.lastname: Karanovic
authors.forename: Ante
authors.initials: A
authors.lastname: Ujevic
authors.forename: Zoran
authors.initials: Z
authors.lastname: Dogas
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000458:organization & administration / Q000592:standards*; D001288:Attention / Q000502:physiology; D003071:Cognition / Q000502:physiology*; D017523:Croatia; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling; D011597:Psychomotor Performance / Q000502:physiology*; D011930:Reaction Time / Q000502:physiology; D013997:Time Factors; D014940:Work Schedule Tolerance