Tired and distracted doctors make more errors, study shows

Researcher
Professor Johanna Westbrook, Dr Daniel Sturman
Writer
Melinda Ham
Date
17 April 2019
Faculty
Faculty of Human Sciences; Faculty of Medicine and Health Sciences
Topic

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Next time you rush to the emergency department, cross your fingers that the doctor who examines you doesn’t get interrupted often and has had a good night’s sleep. New research shows this could mean your doctor makes fewer errors.

Doctors who had less than six hours’ sleep were 15 times more likely to make a clinical error than those who’d had a normal night’s rest, a study by Macquarie University has found.

Tired doctor

Peak performance: The research found doctors made fewer errors when they'd had a good night's sleep.

A research team led by Macquarie Professor Johanna Westbrook took established research from the lab and tested it directly in the hospital. Researchers observed 36 doctors in an emergency department over 120 hours and recorded their tasks, and how often they were interrupted or had to multitask.

“We were interested to see what happened when we did the research directly on people in the real world, in an emergency room – from our knowledge this is the first time it’s been done,” says Westbrook, Director of the Centre for Health Systems and Safety Research at Macquarie University's Australian Institute of Health Innovation.

The researchers found the doctors were interrupted eight times an hour on average. Then they got a clinical pharmacist to review the prescriptions the doctors had written in this time.

“We found that there was an association between making a clinical error and being interrupted during that process,” Westbrook says. “Doctors made three times more medication errors when they were interrupted.”

It made us realise that getting a good night’s sleep is incredibly important to your performance.

This research will be presented at the third annual workshop of Macquarie’s Centre for Elite Performance, Expertise, and Training (CEPET) being held on 29 April.

The workshop will highlight how CEPET does cross-disciplinary research applicable to many different fields, with a particular focus this year on the tension between attention and distraction in areas of expertise.

Before observing the doctors in situ, her team also assessed their working-memory capacity – the brain’s system for short-term problem solving and decision-making. “We found that doctors with a high working memory capacity also made significantly fewer errors in the clinical setting, than those with lower working memory capacity, even when interrupted,” she says.

Age was not a factor but sleep definitely was – those doctors who had less than six hours’ sleep were 15 times more likely than those who’d had a normal night’s rest to make a clinical error. “It made us realise that getting a good night’s sleep is incredibly important to your performance,” Westbrook says.

The research was first published in British Medical Journal’s Quality & Safety last year.

Woman on her phone while driving

The CEPET workshop will explore how experts overcome the demands of attention and distraction in highly-skilled tasks, such as in surgery, competitive sport or even driving.

“We rely on experts every day for our health and safety, and often they must operate in hectic environments with many distractions," says Dr Kim Curby, CEPET Deputy Director. "This is particularly problematic considering the human brain is quite limited in terms of the number of tasks it can perform or the amount of information it can process at any one time.

“And the question is: what is the impact on expert performance of this distraction?”

Find a pattern and use less brain power

Daniel Sturman, a post-doctoral researcher at CEPET, will also present his research looking at why some people in high-risk occupations have the ability to work for longer than others without getting as tired.

“We found that people with ‘high cue utilisation’ don’t get so mentally fatigued. This may be because they possess a high capacity to recognise patterns, or cues, in their work,” he says.

Sturman and his colleagues conducted their research on more than 100 operators in 12 control rooms at power plants across Australia. The researchers’ first step was to find out which operators had higher cue utilisation. So they got them to do a visual search task where they had to click on an error. Those people with higher cue utilisation reacted much faster.

Then the researchers went out into the control rooms and observed the operators going about their routine work. The difference was they had an infrared sensor on their forehead so Sturman and his colleagues could assess their brain activity.

“It measured how oxygenated the blood was in the prefrontal cortex,” he says. “The more challenging the activity, the more oxygenated the blood. Those who were good at using cues had lower levels of blood oxygenation.”

Sturman says that the next step will be for researchers to develop ways to train workers so they can improve cue utilisation and work more efficiently, and also find out how the research can apply to other professions – such as air traffic controllers or long distance train and truck drivers.

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