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THE INFLUENCE OF A NIGHT FLOAT CALL SYSTEM ON THE INCIDENCE OF INADVERTENT DURAL PUNCTURE IN OBSTETRIC ANESTHESIA: A RETROSPECTIVE IMPACT STUDY
Abstract Number: GM-06
Abstract Type: Original Research
BACKGROUND: Sleep deprivation and extended work hours are known to affect the quality of medical care. Recently, limiting the work week to 80 hours averaged over 4 weeks has been associated with increased sleep, a reduction in attention failure,  and a decrease in medical errors.  Residents often work 24-hour shifts; however, with the work hour changes, many departments have developed a nightfloat (NF) call system to redistribute resident workload. Our department instituted a 5-day NF system for obstetric anesthesia residents on July 1, 2013. NF systems have been shown to cause sleep disturbances and decreased alertness,  but the impact of such a change on neuraxial technique complications is unknown. We evaluated the incidence of inadvertent dural puncture (IDP) among residents before and after initiation of a NF system.
METHODS: We performed a retrospective chart review of all IDPs that occurred during two six-month periods, July 1 – December 31, 2013 (NF group) and July 1 – December 31, 2012 (standard group). We defined IDP as a frank wet tap or an unintentional spinal catheter immediately after epidural attempt. For each IDP identified, the date, time, trainee level, and type of call were collected. Residents in the NF group were often floated from other services, while residents in the standard group were on the obstetric anesthesia service.
RESULTS: The incidence of IDP increased from 0.75% (20 of 2656 total placements) to 1.4% (39 of 2808 total placements) after institution of NF (p=0.023). While not significant, complications tripled among CA1 residents (7% vs. 20%; p=0.391). CA3 residents from other services had more than twice as many IDPs overnight as residents who were on the obstetric anesthesia rotation (28% vs. 12%, p=0.157). Finally, more IDPs occurred on the last two days among NF residents compared to non-NF residents (75% vs. 46%, p=0.226, Figure).
CONCLUSION: Our results demonstrate a significant increase in IDPs after initiation of a NF system. Progressive fatigue over the course of a NF week may be contributing, as complications occurred more frequently on days 4 and 5. Although further investigation is necessary, consideration of sleep deprivation-related complications and the value of assigning obstetric anesthesia call to residents while on service may be beneficial prior to adopting a NF system.
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