Medical College of Wisconsin Affiliated Hospitals, Inc.
Institutional Policy
COMPANION DOCUMENT TO THE INSTITUTIONAL POLICY - HOUSESTAFF FATIGUE
Programs are encouraged to address the following points as part of faculty and housestaff education on fatigue.
AWARENESS OF SIGNS OF SLEEPINESS
• Fighting sleep in situations in which it is normally easy to stay awake
• Slowed reaction times, decreased focus, poor learning of new tasks
• Easily distracted
• Irritability/mood swings
• Inappropriate humor/lack of professionalism
• Confusion with routine tasks
• Proven higher frequency of medical errors with extended work shifts beyond 24 hours
• Higher frequency of needle sticks and motor vehicle accidents with extended work shifts
TECHNIQUES TO COMBAT FATIGUE DURING GME TRAINING
• Maximize sleep during off-hours
• Regular physical exercise
• Caffeine: onset in 15-30 minutes after consumption, duration is 3-4 hours (beware of caffeine toxicity-see
the following Other Noteworthy Points)
• Sleep: plan naps (15 minutes – 2 hours) if possible before going on call and post-call
o Remember circadian rhythms (easier times to fall asleep) usually 2-4 pm and 2-5 am
• If awakened from sleep by call/page – wait a few moments to clear head before discussing patient care
• Look at work assignments, who is assigned to complex tasks post-call
OTHER NOTEWORTHY POINTS
• Do: Take a nap, drink caffeine containing beverage, get a ride
• Do NOT drive drowsy
• Most adults need 6-8 hours of sleep per 24 hours
• Individuals vary in how they handle sleep debt/sleep deprivation and how much sleep they need. Body cannot be trained to survive on less
• Caffeine Toxicity: effect of excessive caffeine can be felt after consumption for up to 18-24 hours; can lead to insomnia
• Alcohol Dependency Sleep Disorder (ADSD): alcohol can be used inappropriately to aid sleep, its impact is short term. Don’t have to be alcoholic to have ADSD. Long term result is poor sleep
• Post-call: it takes 2 nights minimum to recover from effect of sleep debt that develops from call/sleep deprivation
• The body’s physiological need/drive for sleep increases as sleep is put off