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Observational Study
. 2023 Nov 23;23(1):2317.
doi: 10.1186/s12889-023-17130-4.

"Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach"

Malena Lis Mul Fedele  1 , María Del Pilar López Gabeiras  2 , Guido Simonelli  3   4   5 , Joaquín José Diez  6 , Giannina Julieta Bellone  7   8 , Joaquín Cagliani  9 , Luis Larrateguy  10 , Kumiko Eiguchi  11 , Diego Andrés Golombek  8   12 , Daniel Pedro Cardinali  7 , Daniel Pérez-Chada  2 , Daniel Eduardo Vigo  13   14
Affiliations
Observational Study

"Multivariate analysis of the impact of sleep and working hours on medical errors: a MICE approach"

Malena Lis Mul Fedele et al. BMC Public Health. .

Abstract

Background: The main objective of this study was to describe the relationship between working conditions, sleep and psycho-affective variables and medical errors.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Circadian rhythms; Fatigue; Medical errors; Multiple imputation by chained equations (MICE); Resident physicians; Sleep.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Schematic description of the study design. A total of 661 medical residents participated in the subjective study, but only 436 of them answered the medical error subsection and thus, were included in the medical error analysis. Of the participants, 62 accepted to take part in the objective analysis. However, 24 of them did not respond the questionnaire and were excluded. Only 19 of them had at least six complete days of actigraphy, completed the sleep log correctly and answered the medical error subsection. Additionally, 25 of them had almost three continuous days of temperature register and completed the medical error subsection
Fig. 2
Fig. 2
Sleep characteristics of the medical residents according to the actigraphic data. Shown are mean with 95% CI of: A) total weekly hours of sleep, B) percentage of diurnal sleep at home, C) percentage of total diurnal sleep, D) percentage of nocturnal sleep at home, E) percentage of total nocturnal sleep and F) Composite Phase Deviation index (No medical error group: n = 9; Medical error group: n = 10). Unpaired t-test with Welch’s correction: B) **p = 0.006, C) *p = 0.01, D) **p = 0.006 and E) *p = 0.01
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