Long residency hours linked with impaired performance similar to effects of drinking alcohol

September 06, 2005

During heavy call rotation and long hours, effects on residents' neurobehavioral performance are comparable to the impairment associated with a 0.04 to 0.05 grams percent blood alcohol concentration, according to an article in the September 7 issue of JAMA, a theme issue on medical education.

"Work-related sleep loss and fatigue in medical training has become a source of increasing concern," according to background information in the article. One study found that interns got 5.8 hours less sleep, had 50 percent more attentional mistakes, and made 22 percent more serious errors on critical care units while working a traditional schedule compared with a schedule with less hours. Also, self-reported lifetime rates of motor vehicle crashes and near-miss crashes among residents are 3 and 2.5 times those of nonresident drivers, respectively.

J. Todd Arnedt, Ph.D., from the University of Michigan, Ann Arbor, and colleagues compared post-call neurobehavioral performance of 34 medical residents (18 women, 16 men) after their rotations to examine the effect of extended work hours. The residents were tested after light call rotation (four-week rotations averaging 44 hours per week), light call with alcohol, heavy call (an average of 90 hours per week, every fourth or fifth night, 80 hours after July 2003), and heavy call with placebo. In the light call with alcohol condition, participants' blood alcohol concentrations were raised to 0.05 grams percent. Average age of residents was 28.7 years.

The researchers found that performance impairment during a heavy call rotation was comparable to impairment associated with a .04 to .05 grams percent blood alcohol concentration during a light call rotation. Compared with light call, heavy call reaction times were 7 percent slower and lane variability and speed variability during the simulated driving test were 27 percent and 71 percent greater, respectively. Speed variability was 29 percent greater in heavy call with placebo than light call with alcohol, and there were similar errors and reaction times.

"These findings have important clinical implications. Residents must be aware of post-call performance impairment and the potential risk to personal and patient safety. There should be sleep loss, fatigue and countermeasure education in residency programs. Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters. Additional studies should examine the impact of these operational and educational interventions on resident driving safety and on patient care and safety," the authors conclude.
-end-
(JAMA. 2005; 294: 1025 - 1033. Available pre-embargo to media at www.jamamedia.org.)

Editor's Note: This study was supported by a grant from American Sleep Medicine Foundation (formerly the Sleep Medicine Education and Research Foundation) from the American Academy of Sleep Medicine.

Editorial: Work Hours and Reducing Fatigue-Related Risk - Good Research vs. Good Policy

In an accompanying editorial, Drew Dawson, Ph.D., from the University of South Australia, Adelaide, South Australia, and Phyllis Zee, M.D., Ph.D., from the Feinberg School of Medicine, Northwestern University, Chicago, write, "While there is little doubt that physicians-in-training work long hours and experience chronic sleep restriction over many years, the consequences remain unclear."

"Although the authors [Arnedt et al] acknowledge that these laboratory tests of performance have not been validated against medical tasks, the indirect implication is that residents working 80- to 90-hour weeks are at an equivalent or greater risk compared with an intoxicated physician. This is, without doubt, a notable finding and one that should concern those responsible for patient safety and medical training."

"Despite the appeal of restricting working hours, it is important to consider potential negative ramifications," the editorialists write. "In some scenarios, limiting working hours may increase risk to patients and physicians. For example, restricted working hours may lead to restricted access to health care practitioners through a reduction in the labor supply, insufficient clinical preparation for the 'real world,' increased sleep restriction in senior physicians, or increases in error rates due to work intensification."

They conclude by saying, "Failure to consider the broader issue carries the considerable hazard that well-intentioned policies to reduce fatigue-related risk may not lead to overall improvements in patient safety." (JAMA. 2005; 294: 1104 - 1106. Available pre-embargo to media at www.jamamedia.org.)

The JAMA Network Journals

Related Alcohol Articles from Brightsurf:

Alcohol use changed right after COVID-19 lockdown
One in four adults reported a change in alcohol use almost immediately after stay-at-home orders were issued: 14% reported drinking more alcohol and reported higher levels of stress and anxiety than those who did not drink and those whose use stayed the same.

Changes in hospitalizations for alcohol use disorder in US
Changes over nearly two decades in the rate of hospitalizations and in-hospital deaths from alcohol use disorder in the US were examined in this study.

Associations of alcohol consumption, alcohol-induced passing out with risk of dementia
The risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers was examined in this observational study with more than 131,000 adults.

New alcohol genes uncovered
Do you have what is known as problematic alcohol use?

Does estrogen influence alcohol use disorder?
A new study from researchers at the University of Illinois at Chicago shows that high estrogen levels may make alcohol more rewarding to female mice.

Sobering new data on drinking and driving: 15% of US alcohol-related motor vehicle fatalities involve alcohol under the legal limit
A new study in the American Journal of Preventive Medicine, published by Elsevier, found that motor vehicle crashes involving drivers with blood alcohol concentrations (BACs) below the legal limit of 0.08 percent accounted for 15% of alcohol-involved crash deaths in the United States.

Alcohol-induced deaths in US
National vital statistics data from 2000 to 2016 were used to examine how rates of alcohol-induced deaths (defined as those deaths due to alcohol consumption that could be avoided if alcohol weren't involved) have changed in the US and to compare the results by demographic groups including sex, race/ethnicity, age, socioeconomic status and geographic location.

Cuts in alcohol duty linked to 2000 more alcohol-related deaths in England
Government cuts to alcohol taxes have had dramatic consequences for public health, including nearly 2000 more alcohol-related deaths in England since 2012, according to new research from the University of Sheffield's School of Health and Related Research (ScHARR).

Integrated stepped alcohol treatment for people in HIV care improves both HIV & alcohol outcomes
Increasing the intensity of treatment for alcohol use disorder (AUD) over time improves alcohol-related outcomes among people with HIV, according to new clinical research supported by the National Institutes of Health.

The Lancet:Targets to reduce harmful alcohol use are likely to be missed as global alcohol intake increases
Increasing rates of alcohol use suggest that the world is not on track to achieve targets against harmful alcohol use, according to a study of 189 countries' alcohol intake between 1990-2017 and estimated intake up to 2030, published in The Lancet.

Read More: Alcohol News and Alcohol Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.