Bright-eyed and bushy-tailed? Maybe not after overnight call

Anesthesiology residents typically work between 64 and 70 hours per week. With on-call duty, that can mean working up to 24 hours straight with little or no sleep. Of course, residents aren’t the only ones rubbing their eyes. Many practicing anesthesiologists work long hours and overnights, too. So, what’s a fatigued anesthesiologist to do?

According to Keith J. Ruskin, M.D., who will lead the Sunday session “Fatigue Risk Management: Making Overnight Call Safer,” it’s time to acknowledge this pervasive problem and address it. Dr. Ruskin is Professor of Anesthesia and Critical Care at the University of Chicago.

Keith J. Ruskin, M.D.

“Perhaps you’ve heard a colleague boast about working all night. Maybe you’ve even joked about it yourself. We can’t continue to talk about sleep deprivation in this way. It’s not a badge of honor. It’s a hazard,” said Dr. Ruskin.

Fatigue Risk Management: Making Overnight Call Safer

2:45 – 3:45 p.m.


Overnight shifts can lead to sleep loss, circadian misalignment and sleep inertia for even the most resilient residents. Experiments have demonstrated that just one night without sleep can yield lapses in attention, slower reaction time, impaired visual selective attention, slower working memory and poorer mood.

To make matters worse, residents may be too tired to gauge their own abilities.

“Sleep deprivation studies reveal that after a couple days without sleep, you don’t feel that bad. You don’t realize you’re impaired. You can be on the verge of making a mistake and think you’re fine,” said Dr. Ruskin.

Acute sleep deprivation can actually mimic alcohol intoxication. According to one study, 24 hours without sleep causes an individual’s performance to be equivalent to someone with a blood alcohol content of 0.10%.

To find effective solutions, Dr. Ruskin has researched Fatigue Risk Management programs developed by NASA, the military and nuclear power plant operators.

“Anesthesiology residents have a lot in common with astronauts and fighter pilots,” he said. “They make life-changing decisions quickly and execute tasks that require fine motor skills. They can’t afford to be sleepy.”

Dr. Ruskin will share fatigue-mitigation concepts gleaned from these high-risk industries. Some programs suggest sweeping changes to staffing and scheduling. Other solutions are as simple as upping your caffeine intake, adding naps or taking microbreaks. The broad range of techniques can be easily adapted to a hospital setting or private practice. And they work for both residents and experienced physicians.

Patient safety is certainly the paramount reason to minimize resident fatigue, but it’s not the only one. Sleep deprivation can also take a toll on a physician’s personal life. Taking his own recommendations to heart, Dr. Ruskin no longer drives home after working overnight.

“The risk of a motor vehicle accident is much higher when you’re sleep deprived,” he said.

It’s important for all anesthesiologists, young and old, to learn how to recognize fatigue and take the appropriate steps to combat it.

“During this presentation, I will provide you with effective strategies to make your practice safer,” said Dr. Ruskin. “If we all adopt these strategies, imagine the difference we can make.”

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