Fatigue in Critical Care: Jo Anna Leuck

Is there a specific time during our shift when we are too fatigued to safety practice? That was the question that led to a research project comparing the clinical performance of providers during the first hour of a day shift and the final hour of a string of night shifts. These providers were pulled out of their real-time clinical duties and video-taped while performing simulated critical care cases. The hypothesis was that the day shift providers would out-perform the night shift, but the opposite proved true. Blinded reviewers assigned the day shift providers lower performance scores and noticed some surprising medical errors committed during these simulated cases. So are we “awake” when we come to work? Should some type of case-based warm up exercise be encouraged just prior to a shift? Also, upon reviewing the data, it was found that the majority of the providers studied had been off the day prior to their morning shift. Jan Paderewski, a famous pianist said, “If I miss one day of practice, I notice it. If I miss two days, the critics notice it. If I miss three days, the audience notices it.” Perhaps clinicians, similar to others who are elite in their field, truly need daily practice or some type of deliberate exercise prior to a shift to perform at the highest levels of care. How can we determine when we are not at our maximum level of mental sharpness during a shift? Can anything be done to improve our abilities in real time? This lecture will review the available literature surrounding mental fatigue and critical care based shift work and focus on techniques both before and during shifts to recognize and potentially mitigate any clinical sluggishness and improve patient care.