"Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach".
Circadian rhythms
Fatigue
Medical errors
Multiple imputation by chained equations (MICE)
Resident physicians
Sleep
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
23 Nov 2023
23 Nov 2023
Historique:
received:
09
06
2023
accepted:
01
11
2023
medline:
27
11
2023
pubmed:
24
11
2023
entrez:
23
11
2023
Statut:
epublish
Résumé
The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors. This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed. Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording. Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
Sections du résumé
BACKGROUND
BACKGROUND
The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors.
METHODS
METHODS
This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed.
RESULTS
RESULTS
Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording.
CONCLUSIONS
CONCLUSIONS
Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
Identifiants
pubmed: 37996804
doi: 10.1186/s12889-023-17130-4
pii: 10.1186/s12889-023-17130-4
pmc: PMC10666331
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2317Informations de copyright
© 2023. The Author(s).
Références
BMJ. 2012 Jul 26;345:e4800
pubmed: 22835925
Acad Med. 2006 Dec;81(12):1059-68
pubmed: 17122470
Acad Psychiatry. 2006 Jul-Aug;30(4):352-5
pubmed: 16908615
Arch Intern Med. 2005 Dec 12-26;165(22):2595-600
pubmed: 16344416
Rev Neurol. 2005 Feb 1-15;40(3):150-5
pubmed: 15750899
N Engl J Med. 2010 Jul 8;363(2):e3
pubmed: 20573917
Sleep Med Rev. 2012 Apr;16(2):167-75
pubmed: 21784677
Surgeon. 2011;9 Suppl 1:S8-9
pubmed: 21550001
Rev Esp Cir Ortop Traumatol. 2016 Mar-Apr;60(2):113-8
pubmed: 26739965
JAMA. 2006 Sep 6;296(9):1055-62
pubmed: 16954484
Am J Epidemiol. 2014 Nov 1;180(9):920-32
pubmed: 25301814
Curr Biol. 2012 May 22;22(10):939-43
pubmed: 22578422
Acad Med. 2003 Nov;78(11):1154-63
pubmed: 14604880
J Clin Sleep Med. 2021 Nov 1;17(11):2283-2306
pubmed: 34666885
Sleep Health. 2020 Jun;6(3):374-386
pubmed: 32081596
J Am Coll Surg. 2011 Jul;213(1):29-34; discussion 34-6
pubmed: 21515080
Arch Bronconeumol. 1999 Oct;35(9):422-7
pubmed: 10596338
Chronobiol Int. 2006;23(1-2):497-509
pubmed: 16687322
Arch Intern Med. 2007 Sep 10;167(16):1738-44
pubmed: 17846392
Lancet Oncol. 2007 Dec;8(12):1065-6
pubmed: 19271347
Arthrosc Sports Med Rehabil. 2021 Jul 09;3(4):e1125-e1132
pubmed: 34430893
N Engl J Med. 2005 Jan 13;352(2):125-34
pubmed: 15647575
Surgery. 2015 Apr;157(4):634-41
pubmed: 25704424
Chest. 2017 May;151(5):1156-1172
pubmed: 28012806
Clin Orthop Relat Res. 2015 May;473(5):1600-8
pubmed: 25269530
Am J Med. 2020 Jul;133(7):e343-e354
pubmed: 32061733
Psychol Health Med. 2009 Dec;14(6):654-66
pubmed: 20183538
Sleep. 2019 May 1;42(5):
pubmed: 30722039
Sci Rep. 2016 Dec 08;6:38601
pubmed: 27929109
Sleep. 2003 Mar 15;26(2):117-26
pubmed: 12683469
Rev Fac Cien Med Univ Nac Cordoba. 2021 Dec 28;78(4):371-375
pubmed: 34962747
N Engl J Med. 2004 Oct 28;351(18):1829-37
pubmed: 15509816
J Sleep Res. 2021 Aug;30(4):e13212
pubmed: 33058426
PLoS One. 2018 Nov 12;13(11):e0206840
pubmed: 30418984
Surg Laparosc Endosc Percutan Tech. 2019 Jun;29(3):162-168
pubmed: 30817696
Am J Surg. 2010 Dec;200(6):814-8; discussion 818-9
pubmed: 21146026
J Clin Sleep Med. 2021 Jun 1;17(6):1211-1215
pubmed: 33612160
J Grad Med Educ. 2015 Sep;7(3):349-63
pubmed: 26457139
PLoS One. 2013 Jun 04;8(6):e65072
pubmed: 23750232
Chest. 2019 Nov;156(5):1022-1030
pubmed: 31352036
PLoS Med. 2006 Dec;3(12):e487
pubmed: 17194188
J Surg Educ. 2021 Nov-Dec;78(6):2094-2101
pubmed: 33994335
Curr Sleep Med Rep. 2017 Jun;3(2):104-112
pubmed: 29057204
J Clin Sleep Med. 2015 Aug 15;11(8):931-52
pubmed: 26235159
J Consult Clin Psychol. 1988 Dec;56(6):893-7
pubmed: 3204199
Sleep. 2004 Mar 15;27(2):217-23
pubmed: 15124713
Pediatrics. 2021 Mar;147(3):
pubmed: 33619044
Neurosci Biobehav Rev. 2019 Jan;96:272-289
pubmed: 30391406
Arch Surg. 2012 May;147(5):430-5
pubmed: 22785637
N Engl J Med. 2020 Jun 25;382(26):2514-2523
pubmed: 32579812
Saf Health Work. 2018 Jun;9(2):203-209
pubmed: 29928535
Postgrad Med. 1972 Dec;52(6):81-5
pubmed: 4635613
Clin Med (Lond). 2005 Nov-Dec;5(6):650-2
pubmed: 16411365
Sleep. 2017 Apr 1;40(4):
pubmed: 28329124
Am J Surg. 2021 May;221(5):866-871
pubmed: 32868025
Occup Environ Med. 2007 Nov;64(11):733-8
pubmed: 17387138
Sleep. 2012 Aug 01;35(8):1137-46
pubmed: 22851809
BMJ Open. 2014 Jul 07;4(7):e004916
pubmed: 25001394
J Clin Psychol Med Settings. 2015 Mar;22(1):90-109
pubmed: 25554496
N Engl J Med. 2004 Oct 28;351(18):1838-48
pubmed: 15509817
J Neural Transm (Vienna). 2012 Oct;119(10):1121-32
pubmed: 22488445