Radiologists make significantly more mistakes on the night shift than they do during the day
Radiologists working late hours overnight make “significantly” more errors than they do during the day, according to a new analysis published Tuesday.
Mistakes actually increased during the back-half of the night shift at a rate of roughly 3.7% of cases compared to 2.5% during the earlier portion, Mayo Clinic imaging experts reported in Radiology. Previous studies have noted these trends among residents, but this new analysis targeted board-certified docs and warrants attention from practice leaders, experts advised.
“The error rate was higher despite lower work intensity during night assignments and despite having work schedules exceeding Accreditation Council for Graduate Medical Education guidelines to promote rest,” Maitray Patel, MD, with the Department of Radiology at Mayo’s Phoenix location, and colleagues wrote Aug. 18. “These findings have implications for patient care and quality assurance efforts, and for designing processes to deliver the highest quality of care at lowest cost.”
Patel et al. made their determination by tasking attending physicians with reviewing all body CT studies logged between July 2014 and June 2018. Docs labeled any discrepancies that impacted acute or follow-up care as errors. They then measured mistakes during regular daytime hours between 7 a.m. and 6 p.m. and compared those against the 6 p.m. to 7 a.m. shift.
All told, 32 Mayo Clinic radiologists interpreted 10,090 CT scans during the four-year study period. About 2% (or 44 out of 2,195) of the daytime studies had errors versus 3% on the night-shift side. That number leapt to 3.7% when only accounting for the back half of the late shift, compared to 2.5% on the front end.
With assignment loads falling “well within” ACGME guidance to combat fatigue and burnout, Patel and colleagues speculated that misaligned sleep schedules may be contributing to radiologists’ poor performance.
“If diminished diagnostic accuracy during night assignments is a function of circadian misalignment and fatigue, our work shows it extends beyond residents to radiologists who have completed residency,” the authors wrote. “This has important quality implications, not only for selecting which studies stand to benefit most from increased quality scrutiny, but also for determining how that scrutiny should be implemented,” the team added, suggesting second reads as one remedy.
You can read more of the study in Radiology here, along with a corresponding commentary here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.