• Participants spent 725 hours (23.52 percent) on shifts with fatigue scores indicative of significant impairment

EBM Commentary

1. Selection Bias: Only 13 percent (17 out of 131) of the emergency physicians volunteered to participate. Perhaps those who participated were suffering from sleep issues or those who decided not to volunteer were too tired to be involved.
2. Hawthorne Effect: Participants knew they were in a study focused on sleep. It is possible that simply by being observed they changed their usual sleep habits. This could have impacted the results of the study.
3. Lack of a Comparison: How do these scores compare to other medical specialties or health care workers (nurses, physician assistants, diagnostic imaging, laboratory technologists, etc.)? Are emergency physicians sleep-deprived more, less, or at the same level as others?
4. The Readiscore and Clinical Significance: We do not know from this data whether a poor Readiscore, which indicates significant impairment, results in a clinically important poor patient outcome.

SGEM Bottom Line

Fatigue is a serious issue for emergency physicians’ health, and we need to find ways to mitigate the negative personal impact and any potential negative impact on patient care. 

Case Resolution

You decide that, after going home and getting some much-needed rest, you are going to email the chief of the department, asking that the issue of sleep and fatigue be discussed at the next department meeting.

Remember to be skeptical of anything you learn, even if you heard it on the Skeptics’ Guide to Emergency Medicine.

Thank you to Dr. Justin Morgenstern, an emergency physician and the creator of the #FOAMed project called www.First10EM.com for his help on this review.

References:

1. Knutsson A. Health disorders of shift workers. Occup Med (Lond). 2003;53(2):103-8.
2. Dawson D, Reid K. Fatigue, alcohol and performance impairment. 1997;388(6639):235.
3. Akerstedt T, Wright KP Jr. sleep loss and fatigue in shift work and shift work disorder. Sleep Med Clin. 2009;4(2):257-271.
4. Fowler LA, Hirsh EL, Klinefelter Z, Sulzbach M, Britt TW. Objective assessement of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2023;30(3):166-171.