USA - Power nap relieves physician fatigue

Protected sleep time could be a viable alternative to shorter duty hours

Getting some Z's through the "power nap" can help physicians fight fatigue, according to a study in theJournal of the American Medical Association, published yesterday.

Amid regulatory mandates that cut resident duty hours, researchers examined a way to protect physician sleep time without having to sacrifice the number of resident work hours--which critics have said increases handoffs and therefore risks patient safety.

Researchers from the University of Pennsylvania looked at more than 100 first-year residents from the Hospital of the University of Pennsylvania and the Philadelphia VA Medical Center. The intervention group consisted of interns who worked a 30-hour shift. They had protected sleep periods between 12:30 a.m. and 5:30 a.m., in which they received an average of two to three hours of sleep. During that time, the interns had to give their cell phone to another awake resident to ensure proper coverage of patients.

The residents who had the power nap reported feeling less fatigued after on-call nights and increased their sleep time by half.

Researchers also noted that with the protected time, resident adherence to sleep was "remarkably high," with about 98 percent of interns signing out their cell phones to a designated covering resident.

"This study provides the first evidence that contrary to long held cultural beliefs within the medical community, young doctors are embracing the importance of sleep and looking for ways to increase their own performance to better treat their patients," David Dinges, professor in the Department of Psychiatry at U Penn, said in a research announcement Tuesday.

The subject of resident sleep has been in the national spotlight since the 2009 Institute of Medicine report, which recommended protected sleep time for residents who continuously work 30 hours. Starting in July 2011, the Accreditation Council for Graduate Medical Education (ACGME) ordered that first-year residents cannot work for more than 16 hours at a time.

And last year, The Joint Commission issued a Sentinel Event Alert, declaring thatworker fatigue is linked to adverse events. The accrediting agency suggested hospitals implement a fatigue management plan, among other guidelines.

However, critics of the mandatory ACGME change have questioned the inadvertent effects on patient safety and, more recently, a potential workforce deficit with patient volume under health reform.

"While these restrictions were put into place to help battle fatigue and improve patient care, the one-size-fits-all model has left many wondering whether or not other viable options could be implemented too," Kevin Volpp, staff physician at the Philadelphia VA Medical Center, said in the statement.

Although the study didn't look at the effects on patient outcomes, it found that "strategic napping" could be an alternative to shorter duty hours.

Karen Cheung-Larivee

For more information:
- see the research announcement and watch the video
- here's the study 

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