Centre for Human Drug Research, Leiden, Netherlands.
Department of Obstetrics and Gynecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands.
Am J Obstet Gynecol. 2021 Jun;224(6):617.e1-617.e14. doi: 10.1016/j.ajog.2021.01.019. Epub 2021 Jan 28.
The field of obstetrics and gynecology requires complex decision-making and skills because of unexpected high-risk situations. These skills are influenced by alertness, reaction time, and concentration. Night shifts result in sleep deprivation, which might impair these functions, although it is still unclear to what extent.
This study aimed to investigate whether a night shift routinely impairs the obstetrics and gynecology consultants' and residents' fitness to perform and whether this reaches a critical limit compared with relevant frames of reference.
Residents (n=33) and consultants (n=46) in obstetrics and gynecology conducted multiple measurements (n=415) at precall, postcall, and noncall moments with the fitness to perform self-test. The self-test consists of an adaptive pursuit tracking task that is able to objectively measure alertness, reaction time, concentration, and hand-eye coordination and Visual Analog Scale tests to subjectively score alertness. The test is validated with a sociolegal reference of a 0.06% ethanol blood concentration (the peak level after 2 units of alcohol, the legal driving limit). This equals -1.37% on the objective score and -8.17 points on subjective alertness. Linear mixed models were used to analyze the difference within subjects over a night shift, integrating repeated measures over time.
The overnight objective difference between postcall and precall measurements was -0.62 (P<.05) for residents and 0.28 (P=NS) for consultants, both not exceeding the sociolegal reference as a group. Objective impairment exceeded the reference for 31% of the residents and 28% of the consultants. Subjective alertness decreased in residents (-18.26; P<.001) and consultants (-10.85; P<.001), both exceeding the reference. No residents had to continue work postcall versus 7.8% of the consultants. None of the consultants that had to continue work were in an objective critically impaired state.
This study provides insight and awareness of individual performance after night shifts with clear frames of reference. The performance of residents is negatively and significantly affected by night shifts; therefore, a scheduled day off after a night shift is justified. Consultants showed no overall impairment; however, a quarter did exceed the alcohol limit reference after their night shift. If not logistically feasible to schedule a protected day off after a night shift, our group recommends safe shift scheduling, including options to transfer care after a demanding night shift to prevent working in a compromised state.
由于存在意外的高危情况，妇产科领域需要复杂的决策和技能。这些技能受警觉性、反应时间和注意力集中程度的影响。上夜班导致睡眠不足，可能会损害这些功能，但目前尚不清楚这种损害程度有多大。
本研究旨在调查夜班是否会常规性地损害妇产科顾问和住院医师的工作能力，以及与相关参考标准相比，这种损害是否达到了临界极限。
妇产科住院医师（n=33）和顾问（n=46）在预呼叫、呼叫后和非呼叫时刻进行了多次测量（n=415），使用自我测试来测试工作能力。自我测试包括一个自适应跟踪任务，能够客观地测量警觉性、反应时间、注意力集中程度和手眼协调能力，以及视觉模拟量表测试来主观地评分警觉性。该测试已通过社会法律参考标准 0.06%乙醇血液浓度（2 单位酒精后的峰值水平，法定驾驶限制）进行了验证。这相当于客观分数的-1.37%和主观警觉性的-8.17 分。线性混合模型用于分析夜间轮班期间受试者内的差异，同时整合随时间的重复测量。
住院医师的夜间客观差异为呼叫后和呼叫前测量值之间的差异为-0.62（P<.05），顾问为 0.28（P=NS），两组均未超过社会法律参考标准。客观损害超过参考标准的住院医师占 31%，顾问占 28%。住院医师的主观警觉性下降（-18.26；P<.001），顾问下降（-10.85；P<.001），均超过参考标准。呼叫后没有住院医师继续工作，而顾问中有 7.8%需要继续工作。没有顾问处于客观严重受损状态，需要继续工作。
本研究提供了个体在夜间轮班后的表现洞察和意识，并提供了明确的参考标准。住院医师的表现受到夜间轮班的负面影响，因此，在夜间轮班后安排休息日是合理的。顾问没有表现出整体损害；然而，四分之一的顾问在夜间轮班后超过了酒精参考标准。如果在夜间轮班后安排休息日在后勤上不可行，我们小组建议进行安全的轮班安排，包括在要求苛刻的夜间轮班后选择转移护理的选项，以防止在受损状态下工作。
