Sleep Is for the Wise

The news has been abuzz this week with discussion and debate surrounding the FAA’s release of new rules to prevent fatigue among pilots.

I can understand the rationale behind the rule changes (people’s lives are in pilots’ hands up in those friendly skies and the consequences of pilot fatigue have been deadly).

But all this talk makes me wonder again… How will this conversation about fatigue and safety affect the health care industry (if at all)?

We all know that health needs know no curfew. And so we staff our hospitals and urgent care clinics around the clock to meet the needs of our patients.

But do we really provide the best care at 3 am?

Earlier this year the Accreditation Council for Graduate Medical Education enacted new rules limiting first-year residents to 16-hour shifts. On the nursing front, labor unions help us negotiate for fair hours and overtime wages.

But we still live in a world of 12-hour shifts and long stretches of 4, 5 or even 6 nights worked in a row (or 6 worked out of 7). My friends and Twitter pals who work nights trade stories of fatigue and exhaustion that are all too familiar. My own post on transitioning to nights during my critical care days received a plethora of survival tips. The evidence¬†has shown how detrimental sleep cycle changes can be to our health. Not that I need research to convince me…last year’s migraine saga was proof enough…


The Institute for Healthcare Improvement recently focused on the night shift in one of their WIHI podcasts. They discussed the safety implications of hospital care at night and shared some startling statistics about survival during nighttime emergencies. A couple of very interesting points:

  • Hospitals are usually staffed on the night shift by the least experienced health care professionals (residents and newer nurses).
  • Root cause analysis trends often show that adverse effects occur at night due to hesitation about paging on-call providers and/or admission of unstable patients from emergency departments.

So what do we do with this information? The National Health Service in the UK has put together a Hospital at Night system involving multidisciplinary teams competent in addressing a myriad of medical and patient care issues. Cincinnati Children’s Hospital Medical Center has implemented a “Night Talks” program involving regular huddles between residents, charge nurses and bedside nurses at two points during the night shift, and mandatory consultations with attendings and fellows about troubling situations. They have also encouraged the involvement of bedside nurses in shift handoffs between residents, to improve communication and ensure care teams are all on the same page.

There is some creative, insightful work going on to improve patient safety in the wee small hours of the morning.

What is your work place or clinical site doing to address night shift safety? What would you like to see them implement? 

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