SLEEP AND CLINICAL SAFETY: THE IMPACT OF DEPRIVATION ON PHYSICIANS: A SCOPING REVIEW

Abstract

Objectives: To analyze the prevalence of medical errors committed in hospital institutions by physicians working under sleep deprivation conditions. Methods: This is a scoping review conducted according to PRISMA-ScR guidelines. To define the guiding question, we used the PCC strategy: P (Population): physicians; C (Concept): sleep deprivation; C (Context): medical practice. This resulted in the following guiding question: "What evidence is available on the relationship between sleep deprivation in physicians and the occurrence of medical errors in clinical practice?" The search was performed in PubMed using the keywords "Physicians AND Sleep Disorders AND Medical Errors." Filters applied included: Clinical Study, Clinical Trial, Comparative Study, Observational Study, Randomized Controlled Trial, English, and Humans. A total of 29 articles were retrieved, and after screening titles and abstracts and evaluating full texts, 7 articles met the inclusion criteria. Results: Data analysis revealed a consistent correlation between extended working hours, sleep restriction, and an increase in medical errors. Physicians with shorter workloads showed better neurobehavioral performance, including sustained attention, faster reasoning, more accurate diagnoses, and proper medication dosage. However, two clinical trials reported an increase in error rates among groups with shorter shifts (≤16 hours), possibly due to an increase in total weekly workload. In contrast, some intervention groups with reduced shift lengths also showed fewer errors but reported decreased learning opportunities, indicating physician dissatisfaction. These inconsistencies suggest that optimizing physician work hours to enhance patient safety is complex. Only four out of the seven studies showed clear benefits for patients from reduced working hours. Conclusion: Sleep deprivation is associated with an increased risk of clinical errors among physicians. While shorter shifts may enhance certain cognitive functions, their benefits are inconsistent when overall workload remains high. Furthermore, reduced hours might hinder professional learning. The current evidence is inconclusive and predominantly originates from Europe and the United States, highlighting the need for more research in the Brazilian healthcare context.