Strategies to reduce resident fatigue

Residency Program Insider, December 19, 2006

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Strategies to reduce resident fatigue

Fatigue as a normal response to enforced wakefulness cannot be eliminated from residencies, but it can be managed more effectively. The 2003 ACGME-mandated duty hour restrictions-an 80-hour-per-week mandate-are an integral part of resident fatigue management, but may not be sufficient.

Residents must be monitored for signs of fatigue and educated about strategies such as effective napping, protecting rest time, the prophylactic use of caffeine, and dealing with sleep inertia. Take the following steps to reduce the potential for adverse outcomes due to resident fatigue:

  • Minimize prolonged work (24 hours or less of clinical duties)

  • Protect periods designed to address sleep debt (i.e. the accumulated hours of sleep needed to make up for sleep hours lost)

  • Reduce non-essential tasks and interruptions (e.g. ancillary services, phone calls, pages) during call

  • Help residents identify co-existent medical issues that impair sleep (e.g. undiagnosed sleep disorders, depression, stress)

  • Educate residents about the need to manage fatigue

  • Arrange space where naps can be taken without disturbance

  • Explore transportation options for residents after night shift or on-call duty

  • Caffeine may be helpful if used pharmacologically

  • Brief (15-20 minutes), frequent (every 2-3 hours) naps are useful especially if used earlier in the time period in which sleep loss is anticipated

  • Longer naps may result in sleep inertia (a feeling of grogginess after awakening and temporarily reduces your ability to perform even simple tasks)

  • Treat sleep inertia by standing up, turning on bright lights, increasing physical activity, showering, increasing metabolic activity

    All the best,

    Kathryn Andolsek

    MD, MPH
    Associate director of graduate medical education
    Duke University Medical Center
    Durham, NC

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