Irish surgeons working “on call” are sleep deprived, which is leading to diminished work performance, particularly in tasks that are more cognitively demanding, according to a new study.
The research from the School of Medicine at Trinity College Dublin investigates the effect of sleep deprivation on surgical performance. It is the first of its kind to focus on Irish surgeons and was published in the Journal of Surgical Research on Wednesday.
Surgeons frequently work 24 straight hours or more, resulting in unavoidable sleep disturbance. The researchers recruited surgical trainees and consultants in the Dublin region and explored subjective and objective metrics around sleep and performance.
The study, which focused on the effects of being on-call, found that surgeons were already sleep deprived before their shifts began, and were even more sleep deprived afterwards. Crucially, it established that sleep deprivation impacted surgical performance.
The surgeons in the study had early onset sleep latency before going on-call, which was exacerbated further in post-call settings. Sleep latency refers to the time it takes to go from being fully awake to sleeping and is often an indicator of sleepiness.
Early onset sleep latency was worse in trainees compared with consultants, but both groups experienced early onset sleep latency post-call.
On-call models
The research found that current models of surgical on-call work were not conducive to optimising sleep for surgeons.
However, it acknowledged there are challenges associated with making changes to ensure better sleep for surgeons, such as the loss of continuity of patient care, loss of trainee exposure, and reduced service delivery.
Lead researcher Dale Whelehan said the findings indicated that current provision of on-call models precluded the opportunity for surgeons to get enough rest.
“Surgeons are sleep deprived before going on-call, which further perpetuates the issue,” he said. “The implications for performance suggest aspects of surgeons’ performance is diminished, particularly tasks which might be more cognitively demanding.
“We need meaningful engagement from all stakeholders in the process, working towards the common goal of optimising performance in surgeons. This involves looking at the multifactorial causes and effects of fatigue.
“Part of that discussion involves consideration around how current models of on-call influence sleep levels in healthcare staff, and how it creates barriers to fatigue management in staff.
“The current situation needs urgent attention. Policy makers must ensure appropriate work-life balance legislation is in place with appropriate resourcing.”
He added that institutions “must enforce this legislation” and healthcare staff must “professionally and personally internalise and adhere to recommended guidelines”.
The study was supervised by Prof Paul Ridgway of the Department of Surgery in Trinity College.
“Our study is further evidence that the way we deliver emergency work alongside normal work in Ireland has to change,” said Prof Ridgway. “We need to learn from our colleagues in aviation who have mandatory rest periods before flights.”
