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. 2012 Jan-Mar;16(1):86-97.
doi: 10.3109/10903127.2011.616261. Epub 2011 Oct 24.

Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers

P Daniel Patterson  1 , Matthew D Weaver, Rachel C Frank, Charles W Warner, Christian Martin-Gill, Francis X Guyette, Rollin J Fairbanks, Michael W Hubble, Thomas J Songer, Clifton W Callaway, Sheryl F Kelsey, David Hostler
Affiliations

Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers

P Daniel Patterson et al. Prehosp Emerg Care. 2012 Jan-Mar.

Abstract

Objective: To determine the association between poor sleep quality, fatigue, and self-reported safety outcomes among emergency medical services (EMS) workers.

Methods: We used convenience sampling of EMS agencies and a cross-sectional survey design. We administered the 19-item Pittsburgh Sleep Quality Index (PSQI), 11-item Chalder Fatigue Questionnaire (CFQ), and 44-item EMS Safety Inventory (EMS-SI) to measure sleep quality, fatigue, and safety outcomes, respectively. We used a consensus process to develop the EMS-SI, which was designed to capture three composite measurements of EMS worker injury, medical errors and adverse events (AEs), and safety-compromising behaviors. We used hierarchical logistic regression to test the association between poor sleep quality, fatigue, and three composite measures of EMS worker safety outcomes.

Results: We received 547 surveys from 30 EMS agencies (a 35.6% mean agency response rate). The mean PSQI score exceeded the benchmark for poor sleep (6.9, 95% confidence interval [CI] 6.6, 7.2). More than half of the respondents were classified as fatigued (55%, 95% CI 50.7, 59.3). Eighteen percent of the respondents reported an injury (17.8%, 95% CI 13.5, 22.1), 41% reported a medical error or AE (41.1%, 95% CI 36.8, 45.4), and 90% reported a safety-compromising behavior (89.6%, 95% CI 87, 92). After controlling for confounding, we identified 1.9 greater odds of injury (95% CI 1.1, 3.3), 2.2 greater odds of medical error or AE (95% CI 1.4, 3.3), and 3.6 greater odds of safety-compromising behavior (95% CI 1.5, 8.3) among fatigued respondents versus nonfatigued respondents.

Conclusions: In this sample of EMS workers, poor sleep quality and fatigue are common. We provide preliminary evidence of an association between sleep quality, fatigue, and safety outcomes.

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Figures

Figure 1
Figure 1. Association between poor sleep quality scores and fatigue
Notes: This box plot illustrates medians, the 25th and 75th percentiles, and range of PSQI scores stratified by fatigue status.
Figure 2
Figure 2. Crude and cluster/confounding-adjusted odds of safety outcomes associated with poor sleep and fatigue
Notes: Adjusted odds ratios from Table 3. These ORs were adjusted for clustering within agencies and confounding.
See this image and copyright information in PMC

References

    1. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294–1300. - PubMed
    1. Kohn LT, Corrigan JM, Donaldson MS. To Err is Human: Building a Safer Health System. Washington, DC: National Academies of Science; 2000. - PubMed
    1. WHO. WHO Patient Safety Curriculum Guide for Medical Schools. Geneva: 2009.
    1. Nasca TJ, Day SH, Amis ES, Force ADHT. The new recommendations on duty hours from the ACGME Task Force. N Engl J Med. 2010;363(2) - PubMed
    1. Rittenberger JC, Beck PW, Paris PM. Errors of omission in the treatment of prehospital chest pain patients. Prehosp Emerg Care. 2005;9(1):2–7. - PubMed

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