Effects of time of day and surgery duration on adverse events in anaesthesia
While the effects of fatigue on clinical performance are measurable, these decrements in performance have not been clearly linked to adverse clinical outcomes for patients. This research evaluated existing peri-operative data from 90, 159 surgical procedures for effects of time of day and surgery duration on the incidence of anaesthetic adverse events (AEs). Events were categorized into different AEs that reflected specific errors, instances of harm, and other AEs that could not be definitively described as error or harm. The results revealed a significant increase in harm events and other AEs in the late afternoon. The predicted probability of both other AEs and harm events more than doubled for late afternoon (3-4 pm) starts compared to morning starts. The data suggest that factors such as the afternoon circadian low point, end of day fatigue, and afternoon hand-offs may be influencing the rate of anesthetic AEs for cases that start in the late afternoon.
Wright, MC; Andregg, BC; Mark, JB; Stafford-Smith, M; Grichnik, KP; Phillips-Bute, B; Taekman, JM
Healthcare Systems Ergonomics and Patient Safety: Human Factor, a Bridge Between Care and Cure - Proceedings of the International Conference HEPS 2005
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