Fatigue and extended work hours among cardiovascular perfusionists: 2010 Survey

Abstract

Due to the emergent unpredictable nature of cardiac surgery, perfusionists, potentially, are susceptible to extended work hours and acute sleep deprivation. While fatigue among other healthcare clinicians has been studied, there has been no research on this topic specifically in the perfusion community. Therefore, the purpose of this study was to: (1) collect preliminary data on the prevalence of fatigue in perfusion and (2) identify if there were concerns regarding fatigue, performance and perfusion safety. In May 2010, a link to a 50-question survey (surveymonkey.com) was posted on Perflist and Perfmail. The survey was closed in July 2010. There were 445 respondents and data were analyzed and expressed as a response percent. Participants included 27% chief perfusionists/managers, 67% staff perfusionists, and 6.0% other (perfusion education faculty, retired perfusionists, locum tenens). Regarding extended work hours, 68.9% of surveyed perfusionists have worked at the hospital for greater than 23 hours straight and 17.5% have worked continuously for over 36 hours. Actual performance of cardiopulmonary bypass (CPB) after 17, 23, and 36 hours of wakefulness was reported by 82.9%, 63% and 14.8% respondents, respectively. Regarding bathroom requirements while on CPB, 87.5% have felt extremely uncomfortable at least once, 19.9% have relieved themselves in the operating room at least once, and 22.3% have left the pump attended by a non-perfusionist to use the restroom at least once. Microsleep during CPB was reported by 49.5% of respondents. Automobile accidents attributed to an extended period of work and fatigue was reported by 6.9% and another 44.4% reported a near-miss auto accident. A fatigue-related minor error was reported by 66% and 6.7% admit to having a serious perfusion accident believed to be due to fatigue. Concerning critical phases of bypass, 51.5% believe that they perform less effectively when fatigued. Additionally, 75.9% indicate that they have been concerned about their ability to perform their job adequately due to fatigue-related acute sleep deprivation. Opinions regarding workplace management were as follows; 48% believe that fatigue can play a role in our profession and managers should do what they can to provide a rested staff, but, unfortunately, it is impractical to set work limits; 32.2% believe fatigue issues should be taken more seriously and specific guidelines should be stated by our professional organizations and 13.4% believe that limits should be established, legislated, and enforced by state or federal authorities. Based upon this preliminary survey data, it appears that fatigue and acute sleep deprivation is a significant safety concern in the perfusion community. Further research must be performed to understand actual performance degradation that may occur in fatigued perfusionists performing CPB.