Abstract
Sleep-related impairment in physicians is an occupational hazard associated with long and sometimes unpredictable work hours and may contribute to burnout and self-reported clinically significant medical error. To assess the associations between sleep-related impairment and occupational wellness indicators in physicians practicing at academic-affiliated medical centers and the association of sleep-related impairment with self-reported clinically significant medical errors, before and after adjusting for burnout. This cross-sectional study used physician wellness survey data collected from 11 academic-affiliated medical centers between November 2016 and October 2018. Analysis was completed in January 2020. A total of 19 384 attending physicians and 7257 house staff physicians at participating institutions were invited to complete a wellness survey. The sample of responders was used for this study. Sleep-related impairment. Association between sleep-related impairment and occupational wellness indicators (ie, work exhaustion, interpersonal disengagement, overall burnout, and professional fulfillment) was hypothesized before data collection. Assessment of the associations of sleep-related impairment and burnout with self-reported clinically significant medical errors (ie, error within the last year resulting in patient harm) was planned after data collection. Of all physicians invited to participate in the survey, 7700 of 19 384 attending physicians (40%) and 3695 of 7257 house staff physicians (51%) completed sleep-related impairment items, including 5279 women (46%), 5187 men (46%), and 929 (8%) who self-identified as other gender or elected not to answer. Because of institutional variation in survey domain inclusion, self-reported medical error responses from 7538 physicians were available for analyses. Spearman correlations of sleep-related impairment with interpersonal disengagement (r = 0.51; P < .001), work exhaustion (r = 0.58; P < .001), and overall burnout (r = 0.59; P < .001) were large. Sleep-related impairment correlation with professional fulfillment (r = -0.40; P < .001) was moderate. In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleep-related impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53% (odds ratio, 1.53; 95% CI, 1.12-2.09), 96% (odds ratio, 1.96; 95% CI, 1.46-2.63), and 97% (odds ratio, 1.97; 95% CI, 1.45-2.69), respectively. In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error. Interventions to mitigate sleep-related impairment in physicians are warranted.
Highlights
In a multivariate model adjusted for gender, training status, medical specialty, and burnout level, compared with low sleeprelated impairment levels, moderate, high, and very high levels were associated with increased odds of self-reported clinically significant medical error, by 53%, 96%, and 97%, respectively
In this study, sleep-related impairment was associated with increased burnout, decreased professional fulfillment, and increased self-reported clinically significant medical error
In a profession in which excessive, often unpredictable work hours are expectations,[1,2,3] sleep-related impairment is an occupational hazard for physicians.[4,5]
Summary
In a profession in which excessive, often unpredictable work hours are expectations,[1,2,3] sleep-related impairment is an occupational hazard for physicians.[4,5] The evidence that inadequate sleep has significant health and cognitive performance consequences is robust.[6,7,8,9] Sleep deprivation disrupts connectivity and processing within and between the amygdala, anterior cingulate, and medial prefrontal cortex, resulting in emotional dysregulation.[10,11,12,13,14] sleep deprivation decreases ability to discern[13,15,16] and mirror emotions,[9] which may decrease physicians’ capacity for empathy and interpersonal engagement. Insufficient sleep results in reduced capacity to maintain attention—including dose-dependent attention gaps proportional to increasing hours awake18,19—associated with reduced intraparietal sulcus and dorsolateral prefrontal cortex activity.[20,21] Attention gaps associated with sleep-related impairment[18,19] may affect physicians’ ability to perform critical cognitive tasks of patient care, including assessment and treatment planning
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