According to Gaba, who directs VA's Patient Safety Center of Inquiry in Palo Alto, fatigue among health care workers probably presents a danger well outside the bounds of what is accepted from any other high-hazard occupation.
The authors included working shorter shifts, and limiting high-intensity work to normal daylight hours among the changes they suggest in their policy analysis. Such changes might promote harmony with the body's natural sleep cycle, and improve patient safety.
"We need to come to grips with this issue, not only for clinicians in training, but for experienced doctors and nurses as well," said Gaba. "Dealing with it is a very complicated business, but we can't just pretend that it's not an issue."
Airline pilots and truck drivers work under strict guidelines to prevent fatigue-related errors, but no comparable comprehensive regulations exist for medical professionals. Although there is no clinical proof that tired doctors and nurses are dangerous for patients, Gaba and Howard say the risk is obvious.
"It defies logic to think that fatiguerelated impairment doesn't play a significant role in performance and safety issues in the medical field, when so many other industries acknowledge the inherent risks," said Gaba. "We believe, for the same reasons that society regulates and limits fatigue impairment in the interest of safety, that it is a safety issue in health care, too. That goes for the safety of clinicians themselves as wel