Stanford University School of Medicine, Palo Alto, California.
Boston Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2020 Dec 1;3(12):e2028111. doi: 10.1001/jamanetworkopen.2020.28111.
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.
DESIGN, SETTING, AND PARTICIPANTS: 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.
睡眠相关障碍是医师职业危害的一个因素，与工作时间长且有时难以预测有关，可能导致倦怠和自我报告的临床显著医疗差错。
评估在学术附属医疗中心工作的医师的睡眠相关障碍与职业健康指标之间的关联，以及在调整倦怠后，睡眠相关障碍与自我报告的临床显著医疗差错之间的关联。
设计、设置和参与者：这是一项使用 2016 年 11 月至 2018 年 10 月期间从 11 个学术附属医疗中心收集的医师健康调查数据进行的横断面研究。分析于 2020 年 1 月完成。邀请参加机构的 19384 名主治医生和 7257 名住院医生完成健康调查。使用响应者样本进行了这项研究。
睡眠相关障碍。
在数据收集之前，假设了睡眠相关障碍与职业健康指标（即工作疲惫、人际脱节、整体倦怠和专业成就感）之间的关联。在数据收集后，计划评估睡眠相关障碍和倦怠与自我报告的临床显著医疗差错（即过去一年中导致患者伤害的差错）之间的关联。
在所有被邀请参加调查的医生中，19384 名主治医生中有 7700 名（40%）和 7257 名住院医生中有 3695 名（51%）完成了睡眠相关障碍项目，包括 5279 名女性（46%）、5187 名男性（46%）和 929 名（8%）自我认定为其他性别或选择不回答。由于机构调查领域的差异，可分析 7538 名医生的自我报告医疗差错反应。睡眠相关障碍与人际脱节（r=0.51；P<0.001）、工作疲惫（r=0.58；P<0.001）和整体倦怠（r=0.59；P<0.001）的相关性较大。睡眠相关障碍与专业成就感（r=-0.40；P<0.001）的相关性中等。在调整性别、培训状态、医学专业和倦怠水平的多变量模型中，与低睡眠相关障碍水平相比，中、高和非常高的睡眠相关障碍水平与自我报告的临床显著医疗差错的几率增加有关，分别为 53%（比值比，1.53；95%置信区间，1.12-2.09）、96%（比值比，1.96；95%置信区间，1.46-2.63）和 97%（比值比，1.97；95%置信区间，1.45-2.69）。
在这项研究中，睡眠相关障碍与倦怠增加、专业成就感下降和自我报告的临床显著医疗差错增加有关。有必要对医师的睡眠相关障碍进行干预。
