TY - JOUR
T1 - The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance
AU - Hanna, Tarek N.
AU - Zygmont, Matthew E.
AU - Peterson, Ryan
AU - Theriot, David
AU - Shekhani, Haris
AU - Johnson, Jamlik Omari
AU - Krupinski, Elizabeth A.
N1 - Publisher Copyright:
© 2017 American College of Radiology
PY - 2018/12/1
Y1 - 2018/12/1
N2 - Purpose: The aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance. Methods: This experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday (“not fatigued”) and another in the morning after an ONS (“fatigued”). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded. Results: Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P < .01). Overall, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state (P < .05). Total viewing time per case was longer when fatigued (35.9 ± 25.8 seconds) than not fatigued (24.8 ± 16.3 seconds) (P < .0001). Total viewing time per case was longer for residents (P < .05). Mean total fixations generated during the search increased by 60% during fatigued sessions (P < .0001). Mean time to first fixate on the fracture increased by 34% during fatigued sessions (P < .0001) and was longer for residents (P < .01). Dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased. Conclusions: After ONS, radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents.
AB - Purpose: The aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance. Methods: This experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday (“not fatigued”) and another in the morning after an ONS (“fatigued”). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded. Results: Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P < .01). Overall, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state (P < .05). Total viewing time per case was longer when fatigued (35.9 ± 25.8 seconds) than not fatigued (24.8 ± 16.3 seconds) (P < .0001). Total viewing time per case was longer for residents (P < .05). Mean total fixations generated during the search increased by 60% during fatigued sessions (P < .0001). Mean time to first fixate on the fracture increased by 34% during fatigued sessions (P < .0001) and was longer for residents (P < .01). Dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased. Conclusions: After ONS, radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents.
KW - Fatigue
KW - medical error
KW - overnight
KW - radiology
KW - search pattern
UR - http://www.scopus.com/inward/record.url?scp=85040646718&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040646718&partnerID=8YFLogxK
U2 - 10.1016/j.jacr.2017.12.019
DO - 10.1016/j.jacr.2017.12.019
M3 - Article
C2 - 29366599
AN - SCOPUS:85040646718
SN - 1546-1440
VL - 15
SP - 1709
EP - 1716
JO - Journal of the American College of Radiology
JF - Journal of the American College of Radiology
IS - 12
ER -