Lit Matters #3: Sleep and Fatigue Risk in EM Physicians

Emergency physicians spend a meaningful share of clinical time in fatigue states associated with impaired performance and higher error risk. Wearable sleep data suggest the signal is not limited to nights: later shift starts, especially afternoons, may carry circadian penalties, while individual variation appears to matter even more.

Sleep and Fatigue in EM

• Fatigue exposure on shift: Emergency physicians spent about 25% of work periods in lower readiness states, a level associated with impaired performance and elevated risk of error rather than simple end-of-shift tiredness.
• Average sleep duration: Mean sleep time was 6.77 hours per day, below the usual 7 to 9 hour adult target, reinforcing that baseline sleep debt may be built into routine emergency practice.
• Poor sleep quality signal: Sleep quality averaged 7.71 on a 10-point scale where lower is better, pointing to fragmented, less restorative sleep even when total sleep time looked only modestly reduced.
• Later shift circadian effect: Later shift starts were linked to slightly lower readiness scores, with afternoon starts showing a concerning signal that challenges the usual focus on overnight work alone. We get into that nuance in the episode.
• Individual variation dominates: Between-physician differences in readiness were much larger than the effect of shift start time, suggesting personal sleep vulnerability and scheduling fit may matter more than any single roster rule.