ASEM Best Paper Prizes 2010
Terrigal EM Conference, New South Wales 2010
"Fatigue in Emergency Registrars"
Authors: Julia Haire, Sally Ferguson, James Tilleard, Matthew Thomas, Paul Negus, Adrian Weissenfeld and Jillian Dorian;
Department of Emergency Medicine, Nambour General Hospital, Sunshine Coast District, Queensland, Australia Centre for Sleep Research, Division of Education, Arts and Social Sciences, University of South Australia, Adelaide, South Australia
Objective: To evaluate the effect of working consecutive night shifts on sleep time, prior wakefulness, perceived levels of fatigue and performance on a psychometric test in a group of emergency registrars working an Australian emergency department.
Methods: A prospective observational study with a repeated within-subjects component was conducted. The amount of time slept during consecutive day and night shifts was determined using sleep diaries and actigraphs. Subjective fatigue levels before and after both day and night shifts was measured. Reciprocal Reaction Times (RRT), using the Psychomotor Vigilance Test (PVT), was evaluated before and after both day and night shifts.
Results: A total of 11 registrars participated in the study with n=80 night shifts and n=40 day shifts and n=107 night shift PVT trials and n=48 day shift PVT trials available for analysis. Sleep time during the run of night shifts was found to be similar to sleep time during the run of day shifts. Time spent awake prior to the start of a night shift was significantly greater than time spent awake prior to the start of a day shift. The mean number of hours spent awake prior to the end of a night shift was 14.33 (13.56-15.10) hours. Subjective fatigue scores became significantly worse over any shift and were worst at the end of a night shift. The RRT was significantly worse at the end of the night shift compared to the beginning of a night shift but was significantly better at the start of a night shift compared with the start of the day shift. There was no difference in RRT between the end of a night shift and the beginning of a day shift.
Conclusion: Registrars sleep a similar amount of time on night shifts as they do on day shifts. Despite reporting the highest levels of fatigue at the end of a night shift there is no significant difference in RRT at the end of a night shift compared to the beginning of a day shift. This correlates with the finding that at the end of a night shift the registrars have, on average, not been awake for greater than 16 hours which is the critical point at which decline in psychomotor performance is expected to commence.
