Improving Alertness and Performance in Emergency Department Physicians and Nurses: The Use of Planned Naps

Rebecca Smith-Coggins, Steven K. Howard, Dat T. Mac, Cynthia Wang, Sharon Kwan, Mark R. Rosekind, Yasser Sowb, Raymond Balise, Joel Levis, David M. Gaba

Research output: Contribution to journalArticle

104 Citations (Scopus)

Abstract

Study objective: We examine whether a 40-minute nap opportunity at 3 am can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts. Methods: This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 am=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 pm), during (4 am), and after (7:30 am) night shifts. A 40-minute driving simulation was administered at 8 am and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded. Results: Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 am, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 am), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68). Conclusion: A nap at 3 am improved performance and subjective report in physicians and nurses at 7:30 am compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

Original languageEnglish (US)
JournalAnnals of Emergency Medicine
Volume48
Issue number5
DOIs
StatePublished - Nov 2006
Externally publishedYes

Fingerprint

Hospital Emergency Service
Nurses
Physicians
Psychomotor Performance
Fatigue
Sleep
Randomized Controlled Trials
Outcome Assessment (Health Care)
Control Groups
Drive

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Improving Alertness and Performance in Emergency Department Physicians and Nurses : The Use of Planned Naps. / Smith-Coggins, Rebecca; Howard, Steven K.; Mac, Dat T.; Wang, Cynthia; Kwan, Sharon; Rosekind, Mark R.; Sowb, Yasser; Balise, Raymond; Levis, Joel; Gaba, David M.

In: Annals of Emergency Medicine, Vol. 48, No. 5, 11.2006.

Research output: Contribution to journalArticle

Smith-Coggins, Rebecca ; Howard, Steven K. ; Mac, Dat T. ; Wang, Cynthia ; Kwan, Sharon ; Rosekind, Mark R. ; Sowb, Yasser ; Balise, Raymond ; Levis, Joel ; Gaba, David M. / Improving Alertness and Performance in Emergency Department Physicians and Nurses : The Use of Planned Naps. In: Annals of Emergency Medicine. 2006 ; Vol. 48, No. 5.
@article{e907e96cd6834623bccaf069ea614c40,
title = "Improving Alertness and Performance in Emergency Department Physicians and Nurses: The Use of Planned Naps",
abstract = "Study objective: We examine whether a 40-minute nap opportunity at 3 am can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts. Methods: This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 am=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 pm), during (4 am), and after (7:30 am) night shifts. A 40-minute driving simulation was administered at 8 am and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded. Results: Polysomnographic data revealed that 90{\%} of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 am, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95{\%} CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95{\%} CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95{\%} CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95{\%} CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95{\%} CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 am), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95{\%} CI: 0.20-1.68). Conclusion: A nap at 3 am improved performance and subjective report in physicians and nurses at 7:30 am compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.",
author = "Rebecca Smith-Coggins and Howard, {Steven K.} and Mac, {Dat T.} and Cynthia Wang and Sharon Kwan and Rosekind, {Mark R.} and Yasser Sowb and Raymond Balise and Joel Levis and Gaba, {David M.}",
year = "2006",
month = "11",
doi = "10.1016/j.annemergmed.2006.02.005",
language = "English (US)",
volume = "48",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "5",

}

TY - JOUR

T1 - Improving Alertness and Performance in Emergency Department Physicians and Nurses

T2 - The Use of Planned Naps

AU - Smith-Coggins, Rebecca

AU - Howard, Steven K.

AU - Mac, Dat T.

AU - Wang, Cynthia

AU - Kwan, Sharon

AU - Rosekind, Mark R.

AU - Sowb, Yasser

AU - Balise, Raymond

AU - Levis, Joel

AU - Gaba, David M.

PY - 2006/11

Y1 - 2006/11

N2 - Study objective: We examine whether a 40-minute nap opportunity at 3 am can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts. Methods: This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 am=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 pm), during (4 am), and after (7:30 am) night shifts. A 40-minute driving simulation was administered at 8 am and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded. Results: Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 am, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 am), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68). Conclusion: A nap at 3 am improved performance and subjective report in physicians and nurses at 7:30 am compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

AB - Study objective: We examine whether a 40-minute nap opportunity at 3 am can improve cognitive and psychomotor performance in physicians and nurses working 12-hour night shifts. Methods: This is a randomized controlled trial of 49 physicians and nurses working 3 consecutive night shifts in an academic emergency department. Subjects were randomized to a control group (no-nap condition=NONE) or nap intervention group (40-minute nap opportunity at 3 am=NAP). The main outcome measures were Psychomotor Vigilance Task, Probe Recall Memory Task, CathSim intravenous insertion virtual reality simulation, and Profile of Mood States, which were administered before (6:30 pm), during (4 am), and after (7:30 am) night shifts. A 40-minute driving simulation was administered at 8 am and videotaped for behavioral signs of sleepiness and driving accuracy. During the nap period, standard polysomnographic data were recorded. Results: Polysomnographic data revealed that 90% of nap subjects were able to sleep for an average of 24.8 minutes (SD 11.1). At 7:30 am, the nap group had fewer performance lapses (NAP 3.13, NONE 4.12; p<0.03; mean difference 0.99; 95% CI: -0.1-2.08), reported more vigor (NAP 4.44, NONE 2.39; p<0.03; mean difference 2.05; 95% CI: 0.63-3.47), less fatigue (NAP 7.4, NONE 10.43; p<0.05; mean difference 3.03; 95% CI: 1.11-4.95), and less sleepiness (NAP 5.36, NONE 6.48; p<0.03; mean difference 1.12; 95% CI: 0.41-1.83). They tended to more quickly complete the intravenous insertion (NAP 66.40 sec, NONE 86.48 sec; p=0.10; mean difference 20.08; 95% CI: 4.64-35.52), exhibit less dangerous driving and display fewer behavioral signs of sleepiness during the driving simulation. Immediately after the nap (4 am), the subjects scored more poorly on Probed Recall Memory (NAP 2.76, NONE 3.7; p<0.05; mean difference 0.94; 95% CI: 0.20-1.68). Conclusion: A nap at 3 am improved performance and subjective report in physicians and nurses at 7:30 am compared to a no-nap condition. Immediately after the nap, memory temporarily worsened. The nap group did not perform any better than the no-nap group during a simulated drive home after the night shift.

UR - http://www.scopus.com/inward/record.url?scp=33749673573&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33749673573&partnerID=8YFLogxK

U2 - 10.1016/j.annemergmed.2006.02.005

DO - 10.1016/j.annemergmed.2006.02.005

M3 - Article

C2 - 17052562

AN - SCOPUS:33749673573

VL - 48

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 5

ER -