Sleep Duration of Health Care Workers Affects Patient Safety, Quality of Care

Patient safety and quality of life are found to be worse when health care workers (HCWs) have short duration and/or low-quality of sleep or are working long and irregular shifts, according to study results published in Behavioral Sleep Medicine.

Although previous research has emphasized the importance of sleep among HCWs, data are limited on the patient experience, quality of care, and outcomes resulting from lack of optimal sleep among these providers.

Researchers conducted a systematic review to understand the effect of sleep duration and quality among HCWs on patient safety and quality of care, as well as impact of shifts and workload.

The researchers searched databases, including Scopus, PubMed, and Embase, using terms such as sleep, health care worker, and patient safety or quality of care. The researchers screened resulting articles were screened and extracted from original, peer-reviewed research. Inclusion criteria were articles with study populations of HCWs, including nurses, doctors, and allied health professionals; objective and subjective measures of sleep health; and outcomes including patient safety, such as adverse events and mortality, and objective and subjective measures of quality of care.

Overall, 7422 articles were identified, of which 30 met the eligibility criteria and were included in the current analysis. The majority of these studies (43%) were conducted in the United States and the most common study population was nurses (53%).

The researchers noted that findings from the research showed insufficient sleep duration and low sleep quality, which commonly resulted in frequent medical errors and poorer quality of patient care. While there were some differences in the studies in the association between sleep-related variables and patient safety and quality of care, many findings indicated some level of association between these factors.

Poor sleep quality among HCWs, assessed using Pittsburgh Sleep Quality Index (PSQI), resulted in more medical and medication errors, as well as reduced motivation, low job efficiency, and reduced performance.

Poorer sleep efficiency was also associated with more errors; however, the degree of errors was observed as minor (eg, incorrect documentation followed up with corrections) and not moderate or severe.

There was differing evidence between studies on the association between PSQI and medical errors.

The researchers found that low sleep duration among HCWs resulted in more medical errors, with increased sleep duration associated with better quality of care. Psychologic and functional factors — sleep and fatigue — also contributed to increased risk for cognitive medical errors.

The researchers also found that the number of night shifts, daytime sleepiness, and working longer shifts were associated with more medical errors among HCWs, with the risk increasing by 1% with every additional hour of work per week. Overall, HCWs working 70 hours or more per week resulted in more errors. Irregular shiftwork and sleep patterns also showed more medication errors.

Limitations of the review included the variation of data across studies, lack of use of validated instruments, and lower standard of evidence.

“Strategies need to be developed and rigorously evaluated to ensure that HCWs have opportunities for sufficient sleep between shifts and can implement proper sleep hygiene,” the researchers concluded.