Less sleep linked to medical errors

Doctors in training are strictly bound by regulations governing how many hours they may work in a week and how much time off they must have between shifts, an outgrowth of research linking medical errors to a lack of sleep. Boston researchers have turned their attention to attending physicians, experienced doctors who perform emergency operations or deliver babies through the night and resume their workload the next day.

Dr. Jeffrey Rothschild of Brigham and Women's Hospital led an eight-year study comparing the rate of complications in procedures a physician performed the day after nighttime procedures to procedures the same physician performed after a night with no procedures.

The researchers found no statistically significant difference in the roughly 5 percent rate of complications, which included infection after surgery or blood loss after deliveries. But if the physician had less than a six-hour opportunity to sleep between the last nighttime procedure and the first one the next day, the complication rate was higher: 6.2 percent for less than six hours compared to 3.4 percent for more than six hours.

"These data suggest that attending physicians, like residents and nurses, may be at increased risk of making errors when sleep deprived or working extended shifts," the authors write in tomorrow's Journal of the American Medical Association.

In an interview, Rothschild said it would be premature to suggest policy changes before the issue is studied across all surgical specialties and in other hospitals. The study looked at a wide variety of specialties but it was conducted in a large, advanced-care, teaching hospital (not identified in the journal article) where resident physicians were available to assist attending physicians. But he said there are lessons that could be applied now.

"For physicians who find themselves in that situation, it's part of professionalism to ask for assistance or postpone a procedure if they feel they are fatigued," he said.