Risk-taking in junior doctors working night shifts in intensive care

Abstract

Sleep deprivation impairs executive function, information processing, visual-spatial perception, psychomotor skills and, importantly, affects clinical performance. Alternating day and night shifts causes circadian misalignment, compounding these deficits . Risk taking, although causally linked to sleep deprivation, has not been reported in doctors working night shifts.

We studied risk taking in 12 healthy junior doctors (below consultant level) working 3-4 consecutive 13h night shifts in neurological and paediatric ICUs . Participants were tested at lunchtime before the first night shift and between 8:30-10:00 am after the last shift. Randomised testing order controlled for practice effects. Eleven participants (9 male); aged 26-36y, completed two computerised tasks at each time point: the Balloon Analogue Risk Task (BART) and the Attention network task (ANT). Wilcoxon-signed rank tests in SPSS v22 (Armonk, NY: IBM Corp) and 95% confidence intervals (CI) for the difference between medians in Confidence Interval Analysis (CIA) software (version 2.2.0) were used in the analysis. The study was approved by the Faculty of Medicine Ethics Committee, University of Southampton.

Participants showed a significant increase in risk taking on the BART (pre-shift median=38.5, post-shift median=45.0; difference between medians with 95% CI=11.4 (3.1 to 20.9); p=0.021). There were no differences in change in BART scores by gender. There was no significant change in ANT scores (see online supplement, below), noteworthy as attention is sensitive to sleep deprivation, indicating that risk taking may be particularly vulnerable to night shift exposure.

What are the professional implications of risk taking? Junior doctors are less risk averse than senior peers and confidence levels in decision-making remain intact during sleep deprivation. Higher levels of risk-taking, without compensatory reduction in confidence, increase the likelihood of clinical error, particularly in an ICU where rapid decisions are necessary. What of the personal consequences? Of 1,135 UK doctors surveyed online, 41% of reported falling asleep whilst driving home after a night shift. Junior doctors may suffer double jeopardy on the roads as risk taking behaviours increase vulnerability to road traffic accidents.

Risk-taking behaviour in junior doctors after ICU night shifts has potentially serious implications for professional practice and personal wellbeing and deserves further study.

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Identifiers

ORCID for R. Hou: orcid.org/0000-0001-6127-1478

ORCID for M. Garner: orcid.org/0000-0001-9481-2226

ORCID for C. Hill: orcid.org/0000-0003-2372-5904

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