A New Model of Work for Anesthesiologists and CRNAs

By December 12, 2017Uncategorized

As a central force in operative care, anesthesiologists are undeniably subject to the mandate of shift work, or designated periods of time in which a person is required to be working a high amount of consecutive hours for his or her employment. Anesthesiologists may take shifts in daytime or after-hours, as there is no time of day limit for surgery. However, different shift times also carry important implications for case volume, episode severity, and procedure type. In a recent article from the Journal of Medical Systems, researchers sought to utilize data from the National Anesthesia Clinical Outcomes Registry to characterize the nature of daytime shifts versus after-hours shifts[1]. They found that in after-hour shifts, patients had increased odds of being in a non-operating room anesthesia environment, with decreased odds for more complex procedures. This result was in contrast to the widespread perception that after-hour procedures are more dangerous — presumably, physicians are more sleep-deprived, and thus are more susceptible to making medical error. Yet, the data shows the very opposite, that in fact, the centers sampled in the National Anesthesia Clinical Outcomes Registry are moving to counteract fatigue effects by scheduling less complex procedures on after-hours shifts.

In addition to simply scheduling less complex procedures for after-hours shifts, in recent years hospital administrators and researchers alike have proposed several potential methods to increase the safety and efficacy of procedures, particularly during after-hours shifts. One such method involves the use of Certified Registered Nurse Anesthetists, or highly specialized Registered Nurses who undergo rigorous training to be experts in the field of anesthesia. CRNAs often experience comparable schedules to anesthesiologists, with approximately 43% of sampled CRNAs reporting on-shift fatigue occurring “often”, or at least once each shift. In a piece for the American Association of Nurse Anesthetists, Domen, R et al reported on strategies that CRNAs implement to reduce the strain of fatigue on quality of work[2]. For example, CRNAs listed specific fatigue prevention tactics, including strategic sleep, increased caffeine and food intake, and naps combined with bright light exposure, that were effective as mediators for reducing medical error. Scholars on the topic emphasize that while individual fatigue prevention techniques can prove impactful, it will take larger policy changes to effect change on an institutional level.

Certain hospitals are experimenting with change. For example, a hospital in Germany has piloted a flexible scheduling program, in which physicians select 13-hour shifts with a mandated break, and self-schedule procedures around these timeslots[3]. While the apex of efficiency is yet to be decided, it is clear that the topic of shift work will remain an engaging discussion in the anesthesia community for years to come.

[1] https://www.ncbi.nlm.nih.gov/pubmed/28776233

[2] https://www.ncbi.nlm.nih.gov/pubmed/26016171

[3] https://www.ncbi.nlm.nih.gov/pubmed/19739361

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