Informed consent a must for sleep-deprived surgeons

In a commentary in the New England Journal of Medicine, doctors recently called for policies to require informed consent from patients before a clinician who is sleep deprived provides clinical care or performs a medical or surgical procedure. They also recommend that institutions implement policies to minimize the likelihood of sleep deprivation before a clinician performs elective surgery and to facilitate priority rescheduling of elective procedures when a clinician is sleep-deprived.

Surveys have shown that if patients knew that their doctor had been awake for 24 hours, 80 percent say they would request a different provider. "Given the data on sleep deprivation, the associated risk of surgical complications, and patient preferences, we believe that hospitals should prohibit the performance of elective surgical procedures when an attending surgeon or anesthesiologist is acutely sleep-deprived-and should ensure priority rescheduling of the canceled surgery," Dr. Michael Nurok, an anesthesiologist at Brigham and Women's Hospital, and co-authors write.

Researchers have documented an 83 percent increase in the risk of complications--such as massive hemorrhage, organ injury or wound failure--in patients who underwent elective daytime surgical procedures performed by attending surgeons who had less than six hours of sleep between procedures during a previous on-call night.

Although it may be hard to assess sleep deprivation and enforce a formal sleep policy that requires the disclosure of clinicians' personal information, the authors write "that the benefit of creating such a policy outweighs the burden," which would involve hospitals absorbing the financial consequences of canceling and rescheduling elective surgeries. The writers note that if outcomes are improved and complications reduced, such steps might ultimately reduce institutional costs.

The authors note that the Sleep Research Society supports legislation that would require physicians who have been awake for 22 of the last 24 hours to inform their patients of the extent and potential impact of their sleep deprivation.

To learn more:
- read the commentary from the New England Journal of Medicine

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