Whether surgeons who become sleep deprived should notify patients who are having elective surgery so that patients can decide whether to postpone the procedure, or request another physician, was the topic of a recent study published in the New England Journal of Medicine.
Sleep deprivation can have as much of an impact as alcohol intoxication on psychomotor and clinical performance, according to the researchers. They pointed out that while the Accreditation Council for Graduate Medical Education has revised its regulations to ensure that trainees in their first postgraduate year work no more than 16 hours in a row, followed by 8 hours off, there are no similar regulations for trained physicians.
“In surgery, there is an 83% increase in the risk of complications (e.g., massive hemorrhage, organ injury, or wound failure) in patients who undergo elective daytime surgical procedures performed by attending surgeons who had less than a 6-hour opportunity for sleep between procedures during a previous on-call night,” the researchers wrote.
Since it is possible to reschedule elective surgery, the researchers suggested that patients should be given the option of postponing, rather than having surgery performed by an exhausted practitioner. The article cites surveys indicating that 80% of patients would request another surgeon if they knew that their physician had been awake for 24 hours. Currently, no regulations exist compelling physicians to inform patients. Concerns about schedules, income, and losing cases may cause clinicians not to involve patients in the decision-making process, according to the researchers.
The authors advocate model legislation from the Sleep Research Society, which would require physicians who had been awake for 22 of the past 24 hours to advise patients about the safety impact of sleep deprivation and obtain informed consent from patients prior to performing elective surgery.
The researchers suggested that patients should be offered the option of rescheduling surgery, proceeding with a different physician, or going ahead with the surgery after signing a consent form acknowledging that they have been informed of the physician’s sleep deprivation and potential consequences but wish to proceed anyway.
While there would be costs involved in rescheduling elective surgeries, the authors believe that the savings from improved patient outcomes and lowered malpractice suits would adequately compensate.