The impact of prolonged continuous wakefulness on resident clinical performance in the intensive care unit: a patient simulator study.
Crit Care Med
; 38(3): 766-70, 2010 Mar.
Article
em En
| MEDLINE
| ID: mdl-20068462
ABSTRACT
OBJECTIVE:
To evaluate the impact of prolonged continuous wakefulness on resident performance under controlled experimental conditions.DESIGN:
Experimental within-subjects comparison.SETTING:
High-fidelity patient simulator.PARTICIPANTS:
Twelve residents in an Internal Medicine Program at various stages of training (range, 1-35 mos). MEASUREMENTS Performance was studied during 26 hrs of continuous wakefulness at four time points (800-1000 am, 200-400 pm, 200-400 am, and 800-1000 am the next day) using high-fidelity patient simulation. At each session, residents managed eight simulated dysrhythmias according to advanced cardiac life support protocols (advanced cardiac life support scenarios) and then managed a simulated critically ill patient (e.g., patient with meningitis) to test more complicated clinical decision-making (complex scenario). The frequency of previously defined major medical errors (i.e., action or inaction that likely would have resulted in significant harm in a real patient) was assessed by a scorer blinded to the time of the session. For each complex scenario, a global score between 0 and 100 was also given for overall performance. The impact of wakefulness on performance was assessed by using longitudinal mixed-effects models.RESULTS:
For the complex scenarios, the mean number of errors increased from 0.92 +/- 0.90 in the first session to 1.58 +/- 0.79 in the fourth session (p = .09), and mean global score decreased from 56.8 +/- 14.6 to 49.6 +/- 12.6 (p = .02). For the advanced cardiac life support scenarios, the mean number of major errors committed in the advanced cardiac life support scenarios decreased during the study period (p = .01). However, essentially all of the improvement occurred between the first and second time points, suggesting that a substantial learning effect accounted for the findings.CONCLUSIONS:
During prolonged continuous wakefulness of medical residents, clinical performance in the management of a simulated critically ill patient deteriorates. The practice of scheduling residents for extended work shifts (>24 hrs) should be reconsidered.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Privação do Sono
/
Vigília
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Tolerância ao Trabalho Programado
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Simulação por Computador
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Competência Clínica
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Erros Médicos
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Unidades de Terapia Intensiva
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Medicina Interna
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Internato e Residência
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Manequins
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Humans
País/Região como assunto:
America do norte
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article