Fatigue and sleepiness of clinicians due to hours of service: A Making Healthcare Safer IV rapid response review

Background The purpose of this review is to summarize the most relevant recent literature on patient safety practices focused on fatigue and sleepiness of clinicians related to hours of service. Methods We conducted a rapid response review, which required strategic adjustments to expedite the review process. These adjustments included being as specific as possible about the questions, limiting the number of databases searched, modifying search strategies to focus on finding the most valuable studies, and restricting the search to studies published recently (i.e. since 2013) that are in English. We used an artificial intelligence (AI) feature of DistillerSR (AI Classifier Manager) as a second reviewer at the title and abstract screening stage. Results Interventions have focused primarily on work schedules, including limiting the number of hours worked in a shift or total over a week, and ensuring adequate time for recovery between shifts. Few studies have addressed fatigue risk management interventions beyond scheduling, but interventions have included lighting, breaks, and scheduled napping. Evidence for the impact of these interventions on patient outcomes is mixed. Conclusions The inconsistent findings from this body of research make it difficult to determine the most appropriate evidence-based policies for mitigating the risk of patient harm from clinician fatigue and sleepiness due to long work hours. More research is needed to determine how to mitigate the risks of patient harm from clinician fatigue and sleepiness due to long work hours.