1. Objective Assessment of Fitness to Perform (FTOP) After Surgical Night Shifts in the Netherlands
- Author
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Tummers, F.H.M.P., Huizinga, C.R.H., Stockmann, H.B.A.C., Hamming, J.F., Cohen, A.F., Bogt, K.E.A. van der, Steenhoven, T.J. van der, Kam, M. de, Pampus, M.G. van, Oordt, C. .J. van, Legemate, D.A., Toorenvliet, B.R., Wever, J.J., Lijkwan, M.A., and FTOP Collaborators more...
- Subjects
Male ,Self-assessment ,Self-Assessment ,night shift ,medicine.medical_specialty ,Consultants ,work hour directive ,MEDLINE ,night call ,Objective assessment ,Cohort Studies ,03 medical and health sciences ,fit to perform ,0302 clinical medicine ,After-Hours Care ,Work Schedule Tolerance ,Task Performance and Analysis ,patient safety ,Humans ,Medicine ,Attention ,Prospective Studies ,sleep-deprived ,Prospective cohort study ,work hours ,alertness ,Netherlands ,Surgeons ,business.industry ,Internship and Residency ,Reproducibility of Results ,organization of care ,Alertness ,Physical Fitness ,General Surgery ,030220 oncology & carcinogenesis ,Physical therapy ,Female ,fatigue ,030211 gastroenterology & hepatology ,Surgery ,Observational study ,Clinical Competence ,business ,Cohort study - Abstract
Background: Surgical skills and decision making are influenced by alertness, reaction time, eye-hand coordination, and concentration. Night shift might impair these functions but it is unclear to what extent. The aim of this study was to investigate whether a night shift routinely impairs the surgeon's fitness to perform and whether this reaches a critical limit as compared to relevant frames of reference.Methods: Consultants (n = 59) and residents (n = 103) conducted fitness to perform measurements at precall, postcall, and noncall moments. This validated self-test consists of an adaptive tracker that is able to objectively measure alertness, reaction time, concentration, and eye-hand coordination, and multiple visual analog scales to subjectively score alertness. Results are compared to sociolegal (ethanol) and professional (operative skills) frames of reference that refer to a decrease under the influence of 0.06% ethanol.Results: Residents spent 1.7 call hours asleep on average as compared to 5.4 for consultants. Subjective alertness decreased in residents after night shifts (-13, P < 0.001) but not in consultants (-1.2, P = NS). The overnight difference in tracker score was -1.17 (P < 0.001) for residents and 0.46 (P = NS) for surgeons. Postcall subjective alertness only correlated to objective alertness in consultants. For residents, hours slept on-call correlated to objective alertness. For consultants, subsequent night calls significantly correlated to objective alertness, with the third subsequent call related to performance below the reference.Conclusions: Consultants remain fit to perform after night call, but subsequent calls may compromise clinical activities. This study provides insight and awareness of individual performance with clear frames of reference. more...
- Published
- 2019
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