A study by the Society of Academic Emergency Medicine assessing sleep and fatigue in emergency medicine physicians found that emergency phsyicians spent almost a quarter of their time in a reduced or significantly impaired state.

The study, published in Academic Emergency Medicine, measured fatigue longitudinally to establish the current state of fatigue risk in emergency medicine. The overall goals were to characterize the percentage of time emergency physicians spent in a fatigued state during shifts and to test the hypothesis that later shift start times would be associated with greater fatigue because of circadian rhythm disruption.

The study assessed sleep and fatigue risk in emergency physicians over the course of two months using a wearable actigraphy device called the ReadiBand. Overall ReadiScores, a fatigue rating from the ReadiBand, demonstrated that emergency physicians spent approximately half of their shift in a high state of cognitive readiness, and they spent almost 25% of their time in a reduced or significantly impaired state.

Unique to this study was the finding that these sleep deficits, along with factors related to shift work, can impact emergency physician fatigue and fatigue risk. In regard to the hypothesis that later start times would be associated with increases in fatigue in a linear manner, researchers actually found a curvilinear relationship between shift start time and Readiscores, such that Readiscores increased for shift start times from 6 a.m. to 2 p.m. but then decreased from 2 p.m. to 11 p.m. This effect may be a function of emergency physicians adjusting to shifts with an early afternoon start time by taking a brief nap prior to the shift, according to the study. 

One of the conclusions of the study was that ReadiScores can be used to index emergency physician fatigue and evaluate interventions designed to reduce fatigue in emergency physician populations.

With this study, lead author Lauren A. Fowler, PhD, professor of neuroscience at Wake Forest School of Medicine, and co-investigators longitudinally and objectively assess fatigue in emergency physicians and demonstrate fatigue risk by shift, laying the groundwork for the future research needed to examine system-level interventions for reducing fatigue in emergency physicians.

The study notes that future research should also attempt to understand how fatigue fluctuates between work and off time.

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