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The Fatigued Anesthetist
Leah Baumgardner RN, SRNA
Sarah Rohrbaugh RN, SRNA
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Objectives
 Describe
contributing factors associated
with workplace fatigue of the anesthesia provider
 Identify
the impact workplace fatigue has on
anesthesia providers
 Identify
patient safety issues arising from fatigued
anesthetists
 Examine
strategies to minimize anesthesia provider
workplace fatigue
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
WAKE UP! QUIZ
True or False: Sleep is a time when your body and
TIME!!!
brain
shut down for rest and relaxation.
 True
or False: The primary cause of insomnia is worry.
 True
or False: The body has a natural ability to adjust to
different sleep schedules such as working night shift or
traveling to different time zones.
 True
or False: People need less sleep as they grow
older.

http://www.nhlbi.nih.gov/about/ncsdr/patpub/patbub-a.htm
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SAF
E
EFFECTI
VE
CONTINUOUS
OBSERVATION
ASSESSMENT OF PATIENTS
RESPONSE
VIGILANC
CIRCADIAN RHYTHM
SLEEP
HOMEOSTASI
S
P
E
R
F
O
R
M
A
N
C
E
Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: doseresponse effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP,
26(2), 117-129.
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Psychomotor performance after 17 hours of wakefulness =
Psychomotor performance of blood/alcohol level of 0.05 - 0.08%
Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639),
235.
AANA CODE OF ETHICS:
“CRNAs preserve human dignity,
respect the moral and legal rights
of health consumers, and
support the safety and well
being of the patients under
their care...”
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Professor William
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Stewart Halsted
Created the first surgical
residency program in 1889
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Libby’s death
sparked creation
of resident duty
hour requirements
Libby Zion
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Internal Factors
Intensity of Work
Caseload
Patient Acuity
Work and On-call Schedules
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The Recommendations
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Seems Simple
So Why Are We Still Fatigued?
Financial Expenditures
Lack of Adequate Staffing
“That’s The Ways It Has Always
Been Done”
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Alertness Management Program
Schedule Policies
Healthy Sleep
Alertness
Strategies
Education
Scientific and
Policy Support
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Sleep Aids vs. Good Sleep Habits
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Alertness Strategies
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In Summary
 Describe contributing factors associated
with workplace fatigue of the anesthesia
provider
 Circadian Disruption and Sleep Debt
 Identify the impact workplace fatigue has
on anesthesia providers
 Health and Performance
 Identify patient safety issues arising from
fatigued anesthetists
 Decreased Vigilance
 Examine strategies to minimize
anesthesia provider workplace fatigue
 Alertness Management Program
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References

Accreditation Council for Graduate Medical Education. (2010, September). ACGME Duty Hours. Retrieved February 10, 2013, from
Accreditation Council for Graduate Medical Education:
http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/Common_Program_Requirements_07012011[1].pdf

American Association of Nurse Anesthetists, (2010). Scope and standards for nurse anesthesia practice. Retrieved from AANA
website: http://www.aana.com/resources2/professionalpractice/Document/PPMScopeandStandards.pdf

American Association of Nurse Anesthetists. (2012, June). American Association of Nurse Anesthetists. Retrieved February 2, 2013,
from Position Statement 2.17 Patient Safety: Fatigue, Sleep and Work Schedule Effects:
http://www.aana.com/resources2/professionalpractice/Documents/PPM%20PS%202.17%20Patient%20Safety.pdf
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Association of perioperative Registered Nurses. (2005). Position Statement on Safe Work/On-Call Practices. Association of
perioperative Registered Nurses.

Biddle, C., & Aker, J. (2011). The national study of sleep-related behaviors of nurse anesthetists: Personal and professional implication.
AANA Journal, 79(4), 324-331. Retrieved from http://www.aana.com/newsandjournal /Documents/sleeprelated_0811_p324-331.pdf
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Czeisler, C. A. (2009). Medical and genetic differences in the adverse impact of sleep loss on performance: Ethical considerations for
the medical profession. Transactions of the American Clinical and Climatological Association, 120, 249-285. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744509/
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Dawson, D., & Reid, K. (1997). Fatigue, alcohol and performance impairment. Nature, 388(6639), 235.
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Howard, S., Rosekind, M. R., Katz, J. D., & Berry, A. J. (2002). Fatigue in anesthesia: Implications and strategies for patient and
provider safety. Anesthesiology, 97 (5), 1281-1294. Retrieved from http://journals.lww.com/anesthesiology
/Citation/2002/11000/Fatigue_in_Anesthesia__Implications_and_Strategies.35.aspx
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Niederee, M. J., Knudtson, J. L., Byrnes, M. C., Helmer, S. D., & Smith, R. S. (2003). A survey of residents and faculty regarding work
hour limitations in surgical training programs. Archives of Surgery, 138 (6), 663-671. doi: 10.1001/archsurg.138.6.663.

Rosekind, M. R. (2005). Managing fatigue 24/7 in health care: Opportunities to improve safety. Anesthesia Patient Safety Foundation
Newsletter, 20(1). Retrieved from http://www.apsf.org/newsletters/html/2005/spring/06managing.htm
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Smith-Coggins, R., Howard, S. K., Mac, D. T., Wang, C., Kwan, S., Rosekind, M. R., et al. (2006). Improving alertness and
performance in emergency department physicians and nurses: The use of planned naps. Annals of Emergency Medicine, 48(5), 596-604.
doi: 10.1016/j.annemergmed.2006.02.005
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Van Dongen, H. P., Maislin, G., Mullington, J. M., & Dinges, D. F. (2003). The cumulative cost of additional wakefulness: doseresponse effects on neurobehavioral functions and sleep physiology from chronic sleep restriction and total sleep deprivation. SLEEP,
26(2), 117-129.