Sleepiness in post-duty house officers

Abstract

Doctors from many departments in Malta’s main acute general hospital, Mater Dei Hospital are rostered to work “post-duty”, which involves working shift of over 30 hours. The majority of studies from a systemic review conducted for this thesis found that, on the whole, function was decreased and sleepiness increased in post-duty doctors. Although practice of working post-duty has been questioned behind closed doors, it has never been formally challenged. Mixed methodology was used to examine sleepiness in house officers post-duty. A cross-sectional analysis was carried out in two parts; pre- and post-duty sleepiness was measured using the Karolinska Sleepiness Scale (KSS) over a period of two and a half weeks. A descriptive phenomenological study sought to describe the lived experience of the phenomenon “working post-duty” in house officers. House officers were significantly sleepier post-duty. The mean difference between pre- and post-duty sleepiness, as measured by KSS, was 3.147 (CI95% 2.957 to 3.337, Paired T-test: P<0.000). The effect size between pre- and post-duty house officers was huge (Cohen’s D = 2.14) and the odds ratio for being excessively sleepy post-duty, as defined by having a KSS of seven or greater, was 57.31. The phenomenological study found three main themes which emerged to describe “working post-duty”: emotional and cognitive sequelae, unmet need and impaired performance. Doctors described that empathy, motivation and emotional energy were decreased post-duty, whilst self-doubt, sleepiness and the desire to drop everything and go home were increased post-duty. Additionally, doctors described that they have come close to having serious motor vehicle accidents post-duty, as well as admitting to disregarding things that they would otherwise lend importance to, such as being empathic with patients, or communicating a discharge plan. House officers have massively increased odds of being excessively sleepy post-duty, which poses a potential risk to themselves and to their patients. Deprivation of a basic need (sleep) may lead to obfuscation of usual occupational motivators (e.g. the need to abide by professional standards such as infection control protocols), leading to suboptimal performance in post-duty doctors. Immediate reform of doctors’ working hours is called for: it is recommended that the precautionary principle be invoked, and doctors are allowed to rest post-duty.