Fatigue among Clinicians and the Safety of Patients

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Abstract
Sleep deprivation due to extended work hours and circadian disruption has long been a concern in medicine.1 It has been called the Achilles' heel of the medical profession.2 The levels of continuous duty and work hours for health care personnel are much greater than those allowed in the transportation and nuclear-power industries.3,4 The problem is most severe for residents in training but extends to experienced physicians and nurses. Clinicians who have been deprived of sleep are part of a health care system in trouble. A report from the Institute of Medicine concludes that the system fails to ensure that patients are safe or that the quality of care they receive is high.5 Kenneth Shine, former president of the institute, stated, “We have nurses working 12-hour sessions back to back; we have house officers working enormous hours. We would never do that if we were designing a good system in terms of quality of care.”6