Physician Fatigue (Medical Errors Management)
In 1984, when Baylor began its liver transplantation program, ischemia times were kept to a minimum because organ preservation techniques were not as good as they are today. As a result, many organ transplants were performed in the middle of the night. It was clear to all in the operating room that between the hours of 1:30 AM and 4:00 AM it was hard to maintain the same level of vigor that was present the rest of the time. As dawn came, the team would become revitalized. Many research projects were also under way with this transplantation program, and it became apparent that many data points were missed during the early morning hours. However, our group was still able to produce many peer-reviewed publications and gain some recognition. At one international meeting, I was asked to give a presentation on “how to do 2 AM research.” This presentation led to a review of the effects of fatigue, one of the major causes of dysfunctional behavior by physicians in the operating room environment and the cause of many medical errors. Recently the Institute of Medicine extrapolated the incidence of adverse events in hospitalized patients from 2 large studies and concluded that at least 44,000–and maybe as many as 98,000–Americans die each year as a result of medical errors (1).