Survey of Obstetric Anesthesia Call Duration
Abstract Number: S-3
Abstract Type: Original Research
Introduction: The impact of resident fatigue on both patient and resident safety has received significant attention. (1, 2) The ACGME limits PGY-1 duty hours to 16 (3). While some have recommended similar restrictions for attending staff (4), no formal limits exist. Little is known about actual work hours of obstetric anesthesiologists. We undertook this study to identify the in-house duty hours of attending anesthesiologists working in obstetrics.
Methods: This study was exempt by our Committee on Clinical Investigation. A 37 question survey was created on survey monkey. The content of this survey was approved by the SOAP Research Committee and a URL link sent to SOAP members. The survey contained questions about: anesthesia practice environment, OB call hours, impact of fatigue on practice, and behaviors used to combat fatigue.
Results: The survey was sent to 1102 SOAP members and we received 236 responses (21.4%). Relevant demographic and practice characteristics include:
• 57.4% male
• 57.9% sub-specialty training in OB anesthesia
• 61.7% reported > 3000 deliveries/yr
• 49.3% reported a C/S rate > 30%
• 89.8% reported an epidural rate > 50%
• 57% described their practice as academic
With regards to duty hours, 20.9% had worked a 25-36 hour shift during the past year, 1.3% 37-48 hours, and 2.6% > 48 hours. A majority felt that their cognitive and technical abilities were impaired between 2 and 6 a.m. (85.5% and 75.7% respectively). 39.6% stated that they had made a clinical error due to fatigue in their career, and 5.1% indicated that this error had caused patient harm.
Those in private practice were more likely to work a shift > 16 hours during weekday call than those in academic practice (50% vs 27.6%), but this difference disappeared on the weekend (56.3% vs 56.6%). Those in private practice also took more weekday and weekend call, and were more likely to think that fatigue did not impair their performance.
Few (4.7%) anesthesiologists routinely napped before driving home post call, and only 38.7% used caffeine to combat fatigue prior to the drive.
Conclusions: We found that a majority of anesthesiologists who take in-house call for obstetrics work < 24 hours, and most work < 16 hours during weekday call. A large number still work 24 hours on the weekend and a concerning number occasionally still work very long shifts (> 36 hours). Anesthesiologists working in large academic practices are over represented in our cohort and are less likely to work > 16 hours, suggesting that the actual number of clinicians working long hours may actually be higher.
1) Landrigan. NEJM. 2004 351;1838-48
2) Lockley. Joint Comm J Qual Pt Safety. 2007. 33:7-18
3) ACGME. Common Program Requirements http://www.acgme.org/acwebsite/home/Common_Program_Requirements_07012011.pdf
4) Recommendations To Improve Maternity Care In Massachusetts. Massachusetts Department of Public Health. http://www.mass.gov/eohhs/docs/dph/patient-saf