To the Editor: We read with interest the recent cover article by Bhonagiri and colleagues detailing increased standardised mortality rates for patients admitted to Australian intensive care units (ICUs) out of hours.1 Have the authors considered a secondary analysis controlling for night-time staffing ratios? Aside from staffing levels, human factors such as the effects of fatigue and sleepiness due to circadian rhythm misalignment and sleep deprivation should be considered and further investigated.
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- 1 Monash University, Melbourne, VIC.
- 2 The Alfred Hospital, Melbourne, VIC.
- 1. Bhonagiri D, Pilcher DV, Bailey MJ. Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis. Med J Aust 2011; 194: 287-292. <MJA full text>
- 2. Rajaratnam SM, Arendt J. Health in a 24-h society. Lancet 2001; 358: 999-1005.
- 3. Marcus L, Liew D, Knott J. The effect of nightshift on emergency registrars’ clinical skills. Emerg Med Australas 2010; 22: 211-215.
- 4. Dijk DJ, Czeisler CA. Contribution of the circadian pacemaker and the sleep homeostat to sleep propensity, sleep structure, electroencephalographic slow waves, and sleep spindle activity in humans. J Neurosci 1995; 15: 3526-3538.
- 5. Cohen DA, Wang W, Wyatt JK, et al. Uncovering residual effects of chronic sleep loss on human performance. Sci Transl Med 2010; 2: 14ra3.
- 6. Folkard S, Tucker P. Shift work, safety and productivity. Occup Med (Lond) 2003; 53: 95-101.
- 7. Rothschild JM, Keohane CA, Rogers S, et al. Risks of complications by attending physicians after performing nighttime procedures. JAMA 2009; 302: 1565-1572.