Chronophysiology Lab, Institute for Biomedical Research (UCA-CONICET), Buenos Aires, Argentina.
Austral University, Austral University Hospital, Pilar, Argentina.
BMC Public Health. 2023 Nov 23;23(1):2317. doi: 10.1186/s12889-023-17130-4.
The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors.
This was an observational, analytical and cross-sectional study in which 661 medical residents answered questionnaires about working conditions, sleep and psycho-affective variables. Actigraphic sleep parameters and peripheral temperature circadian rhythm were measured in a subgroup of 38 subjects. Bivariate and multivariate predictors of medical errors were assessed.
Medical residents reported working 66.2 ± 21.9 weekly hours. The longest continuous shift was of 28.4 ± 10.9 h. They reported sleeping 6.1 ± 1.6 h per day, with a sleep debt of 94 ± 129 min in workdays. A high percentage of them reported symptoms related to psycho-affective disorders. The longest continuous shift duration (OR = 1.03 [95% CI, 1.00-1.05], p = 0.01), working more than six monthly on-call shifts (OR = 1.87 [95% CI, 1.16-3.02], p = 0.01) and sleeping less than six hours per working day (OR = 1.66 [95% CI, 1.10-2.51], p = 0.02) were independently associated with self-reported medical errors. The report of medical errors was associated with an increase in the percentage of diurnal sleep (2.2% [95% CI, 0.1-4.3] vs 14.5% [95% CI, 5.9-23.0]; p = 0.01) in the actigraphic recording.
Medical residents have a high working hour load that affect their sleep opportunities, circadian rhythms and psycho-affective health, which are also related to the report of medical errors. These results highlight the importance of implementing multidimensional strategies to improve medical trainees' sleep and wellbeing, increasing in turn their own and patients' safety.
本研究的主要目的是描述工作条件、睡眠和心理-情感变量与医疗差错之间的关系。
这是一项观察性、分析性和横断面研究，共有 661 名住院医师回答了关于工作条件、睡眠和心理-情感变量的问卷。其中 38 名受试者的睡眠参数和外周温度昼夜节律通过活动记录仪进行了测量。评估了医疗差错的单变量和多变量预测因素。
住院医师每周工作 66.2±21.9 小时。最长连续轮班时间为 28.4±10.9 小时。他们报告每天睡眠 6.1±1.6 小时，工作日有 94±129 分钟的睡眠债务。他们中有很大比例的人报告了与心理-情感障碍相关的症状。最长连续轮班时间（OR=1.03[95%CI，1.00-1.05]，p=0.01）、每月上夜班超过 6 次（OR=1.87[95%CI，1.16-3.02]，p=0.01）和每个工作日睡眠不足 6 小时（OR=1.66[95%CI，1.10-2.51]，p=0.02）与自我报告的医疗差错独立相关。医疗差错的报告与活动记录仪记录的日间睡眠时间百分比增加相关（2.2%[95%CI，0.1-4.3] vs 14.5%[95%CI，5.9-23.0]；p=0.01）。
住院医师的工作时间负荷很高，这影响了他们的睡眠机会、昼夜节律和心理-情感健康，这也与医疗差错的报告有关。这些结果强调了实施多维策略来改善医学实习生的睡眠和幸福感的重要性，从而提高他们自己和患者的安全性。
