Surgeons Maintain Better Focus Working 12-Hour Shifts Compared to 24-Hour Calls

BACKGROUND: In this quality improvement project, we analyzed surgeon focus and attention utilizing a visual tracking device. We hypothesized that surgeons maintained better focus working 12-hour shifts compared to 24-hour calls. MATERIALS AND METHODS: A prospective, quality improvement project was performed on surgery residents, medical students, and attending physicians working at a busy, tertiary referral, safety-net hospital with Level 1 trauma and burn centers. A visual tracking system was used to measure visual attention before and after a 12-hour, in-house shift and a 24-hour, surgical inhouse call. A pupil tracker was utilized to measure attention impairment. Individual performance was rated on a scale of 0 to 6: Severely Impaired- 0; Impaired- 1; Low Average- 2; Average- 3; Above Average- 4; High Average5; Superior- 6. Data were analyzed for homogeneity. The Wilcoxon Ranked Sum was used to assess for statistically significant differences between focus scores in the same group of individuals before and after shifts and/or calls. The Mann-Whitney U test was used to compare differences in focus between 12 and 24 hour in-house shifts and/or calls. RESULTS: A total of 21 surgeons provided a total of 61 visual tracking tests for analysis. Results were found to be nonhomogeneous. The project population was 46% men with a median age of 31 years IQR (28-33). General surgery residents accounted for 48 tests, medical students for 2, and attending surgeons for 11. Average hours of self-reported sleep before the shift/call was 6 (IQR; 6-7). There was almost no overall change in focus in individuals before and after a 12-hour, in-house shift -0.06 (SD 1.9), while after a 24- hour, in-house call, focus decreased by almost 2 full grades -1.8 (SD 1.6) (p = 0.013). There was no statistically significant difference in focus found between 12-hour day shift and 12hour night shift. CONCLUSIONS: Twelve-hour shifts appear to preserve focus in surgeons better compared with 24- hour, in-house calls. More research is needed to establish the optimal time of surgeon focus maintenance and shift duration. (C) 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.