Jo Anna Leuck discusses fatigue in critical care. Is there a specific time during our shift when we are too fatigued to safely practice? That was the question that led to Jo Anna’s research project comparing the clinical performance of providers during the first hour of a day shift and the final hour of a string of night shifts. The providers were pulled out of their real-time clinical duties and video-taped while performing simulated critical care cases. The hypothesis was that the day shift providers would out-perform the night shift, but surprisingly the opposite proved true. Blinded reviewers assigned the day shift providers lower performance scores. Furthermore, they noticed some surprising medical errors committed during these simulated cases. Jo Anna examines how performance is impacted by practise, or lack thereof. She raises examples such as coming in to work after a few days off, or after an extended break and posits that performance will be negatively affected in these circumstances. Perhaps clinicians, similar to others who are elite in their field, truly need daily practice or some type of deliberate exercise prior to a shift to perform at the highest levels of care. How can we determine when we are not at our maximum level of mental sharpness during a shift? Can we improve our abilities in real time? Jo Anna concludes by suggesting some strategies to counteract these drops in performance. Allowing more time to get to work to reduce cognitive load, utilising mental rehearsal and taking advantage of checklists are all explored. In this talk, Jo Anna discusses mental fatigue and critical care-based shift work. She focuses on techniques to recognise and potentially mitigate any clinical sluggishness and improve patient care. For more like this, head to our podcast page. #CodaPodcast

1. Does the Early Bird Catch the
Worm?
Thinking about how we prepare for shifts
Jo Anna Leuck, MD
@JannaLuke
SMACC:DUB 2016

6. 6

8. Study Groups
First Day Shift
First Overnight Shift
Multiple Overnight
Shifts

9. Evaluative Metrics
Critical Actions
Time to Critical
Actions
Clinical Performance
Evaluation

10. Results
NIGHT DAY
CASE SCORE:
7.34
CASE SCORE:
6.32
TIME to DEFIBRILLATE:
168 seconds
TIME to DEFIBRILLATE:
431 seconds
TIME to MAGNESIUM:
234 seconds
TIME to MAGNESIUM
404 seconds

13. Wisdom from the ring
• "You can map out a fight plan or a life plan, but
when the action starts, it may not go the way you
planned, and you’re down to your reflexes –
which means your training. That’s where your
roadwork shows. If you’ve cheated on that in the
dark of morning – well, you’re getting found out
now, under the bright lights."
-- Joe Frazier