Surgeon fatigue: a prospective analysis of the incidence, risk, and intervals of predicted fatigue-related impairment in residents.
OBJECTIVE
A novel approach to identify at-risk periods among orthopedic surgical residents may direct fatigue risk mitigation and facilitate targeted interventions.


METHODS
A prospective cohort study with a minimum 2-week continuous assessment period. Data on sleep and awake periods were processed using the sleep, activity, fatigue, and task effectiveness model.


METHODS
Rotations at 2 academic tertiary care centers.


METHODS
Twenty-seven of 33 volunteer orthopedic surgical residents (82%) completed the study, representing 65% (33 of 51) of the orthopedic residency program.


METHODS
Residents' sleep and awake periods were continuously recorded via actigraphy, and a daily questionnaire was used to analyze mental fatigue.


METHODS
Percentage of time at less than 80% mental effectiveness (correlating with an increased risk of error), percentage of time at less than 70% mental effectiveness (correlating with a blood alcohol level of 0.08%), the mean amount of daily sleep, and the relative risk of medical error compared with chance.


RESULTS
Residents were fatigued during 48% and impaired during 27% of their time awake. Among all residents, the mean amount of daily sleep was 5.3 hours. Overall, residents' fatigue levels were predicted to increase the risk of medical error by 22% compared with well-rested historical control subjects. Night-float residents were more impaired (P = .02), with an increased risk of medical error (P = .045).


CONCLUSIONS
Resident fatigue is prevalent, pervasive, and variable. To guide targeted interventions, fatigue modeling can be conducted in hospitals to identify periods, rotations, and individuals at risk of medical error.
Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA 02494, USA. Fmccormick@partners.org
Frank
F
McCormick
John
J
Kadzielski
Christopher P
CP
Landrigan
Brady
B
Evans
James H
JH
Herndon
Harry E
HE
Rubash
D015331:Cohort Studies; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007396:Internship and Residency; D008297:Male; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology*; D009985:Orthopedics; D010815:Physician Impairment / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index