Shiftwork and emergency medical practice

Shiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. We conducted a systematic literature review to characterize the effects of shiftwork on physician health, well-being and practice, and to describe rational strategies to mitigate its impact on Canadian emergency physicians.

Higher mortality rates among inborn infants admitted to neonatal intensive care units at night

OBJECTIVE

To examine circadian variation in deaths among infants < or =32 weeks' gestation admitted to Canadian neonatal intensive care units (NICU).

STUDY DESIGN

We examined all infants (n=5192) between 24 and 32 weeks' gestation with complete data, who were admitted to 17 tertiary Canadian Neonatal Network NICUs from January 1996 to October 1997. Multivariable logistic regression was used to compare risk-adjusted early neonatal mortality rates (death within 7 days of NICU admission) of infants admitted during daytime (8 am to 5 pm) with infants admitted at night.

RESULTS

Sixty percent (n=3131) of infants were admitted to the NICU at night. Patient risk factors significantly (P<.05) predictive of early neonatal death from multivariable logistic regression were male sex, outborn status, APGAR score <7 at 5 minutes, presence of congenital anomalies, low gestational age, and high admission Score for neonatal acute physiology, version II (SNAP-II). For inborn infants, in-house presence of a neonatal fellow or attending neonatologist at night (odds ratio, 0.6) and NICU admission at night (odds ratio, 1.6) were also predictive.

CONCLUSIONS

Risk-adjusted early neonatal mortality odds was 60% higher among inborn infants < or =32 weeks' gestation admitted to NICUs at night compared with during daytime, equivalent to 29 excess deaths per 1000 infants.

The occupational hazards of emergency physicians

Emergency physicians are exposed to a variety of occupational hazards. Among these are infectious diseases, such the human immunodeficiency virus, hepatitis B and C viruses, and tuberculosis. Hepatitis G virus is transmissible but may not be a cause of illness. The likelihood of being exposed to these agents appears to be higher in the ED than other medical settings but estimates of the prevalence of these diseases in the ED vary, depending on the patient population served. Estimates of risk for contracting these infections are reviewed. Measures to prevent these exposures can reduce risk, but compliance is low, particularly for those involving changes in the behavior of emergency physicians (such as not recapping needles). Latex allergy is a hazard of health care workers. Its prevalence is reported to be quite high, but these findings are difficult to interpret in the absence of a universally accepted definition of the condition. Its prevalence in emergency physicians is not known. Other noninfectious hazards include workplace violence and exposure to nitrous oxide. The health effects of rotating shift work may put emergency physicians at increased risk of coronary artery disease and impaired reproductive health. Emotional stress is another hazard of emergency physicians, and may lead to burnout.

Understanding circadian rhythms: a holistic approach to nurses and shift work

When night shift nurses drive home at 7:30 a.m., the daylight resets their circadian pacemakers in the retina. This daylight exposure amplifies desynchronization of the circadian rhythm. It was found that 3:00 a.m. to 3:00 p.m. and 3:00 p.m. to 3:00 a.m. shifts produced less physiological and emotional stresses. Increased awareness of circadian rhythms may help to reduce the multiple risks to nurses' health and enhance quality of life. This article presents the scientific principles of circadian rhythms and their effects on shift workers' health and illnesses. There is a significant decrease in job performance and in satisfaction and quality of patient care. Statistics indicate that errors, injuries, sick days, and accidents are higher for nurses' working rotating shifts. Eleven recommendations provide ideas to support nurses holistically.