On the topic of procedural complications occurring the day after being on call, an extremely important issue to attending physicians as well as to residents, Jeffrey Rothschild, MD, MPH of our Hospitalist Service and a member of the Division of General Medicine at the Brigham, is the lead author on an article (published in the October 14th Journal of the American Medical Association) on this subject as it pertains to surgeons and to obstetrician/gynecologists.

In 2003 the ACGME reduced resident work hours because of concern about the impact of fatigue, and in 2008 the IOM report on resident duty hours did not comment on attending physician work hour limitations as a way to reduce adverse events. There are more studies about the impact of extended work hours and prolonged periods without sleep for physician trainees than for attending physicians.

In a matched retrospective cohort study, Dr. Rothschild et al. found that while overall procedures performed the day after attending physicians worked overnight were not associated with significantly increased complication rates, among those surgical cases (but not ob/gyn cases) where there was less than six hours of opportunity to sleep, there was in fact a substantially elevated rate of complications.

Dr. Rothschild's findings add to the limited literature on the effects of sleep deprivation and extended work shifts on clinical outcomes. As you may know, Newton-Wellesley is participating with many of these same authors in a large, prospective study of the effect of sleep deprivation on surgeons and obstetricians that holds promise for more definitive answers.

JAMA Article (pdf)

From Leslie G. Selbovitz, MD
Chief Medical Officer