Differences in Day and Night Shift Clinical Performance in Anesthesiology

OBJECTIVE: This study examined whether anesthesia residents (physicians in training) performed clinical duties in the operating room differently during the day versus at night. BACKGROUND: Fatigue from sleep deprivation and working through the night is common for physicians, particularly during residency training. METHODS: Using a repeated-measures design, we studied 13 pairs of day-night matched anesthesia cases. Dependent measures included task times, workload ratings, response to an alarm light latency task, and mood. RESULTS: Residents spent significantly less time on manual tasks and more time on monitoring tasks during the maintenance phase at night than during the day. Residents reported more negative mood at night than during the day, both pre- and postoperation. However, time of day had no effect on the mood change between pre- and postoperation. Workload ratings and the response time to an alarm light latency task were not significantly different between night and day cases. CONCLUSIONS: Because night shift residents had been awake and working for more than 16 hr, the observed differences in task performance and mood may be attributed to fatigue. The changes in task distribution during night shift work may represent compensatory strategies to maintain patient care quality while keeping perceived workload at a manageable level. APPLICATIONS: Fatigue effects during night shifts should be considered when designing work-rest schedules for clinicians. This matched-case control scheme can also be applied to study other phenomena associated with patient safety in the actual clinical environment.