Testing Alertness of Emergency Physicians: A Novel Quantitative Measure of Alertness and Implications for Worker and Patient Care

Background: Establishing practical solutions to manage fatigue in health care settings could reduce errors. Predictive Safety SRP Inc.’s AlertMeter is a 2-min cognitive assessment tool currently used in high-hazard industries to identify fatigued staff. Objective: No prior study has attempted to address fatigue in emergency medicine (EM). We objectively assessed provider alertness to determine potential application of software-based fatigue recognition for risk reduction. Methods: In a double-blind, prospective evaluation from July 1 to September 30, 2016, we applied the AlertMeter to EM residents at an academic level I trauma center. The tool was applied before and after shifts to evaluate alertness in three types of shifts: day, evening, and night. All residents were invited to participate—27 of 30 enrolled. Analysis of covariance (ANCOVA) was implemented to examine shift and completion effects on alertness score using baseline score as a covariate. Additionally, three separate ANCOVAs were conducted to examine alertness score differences between portion (start vs. end) and type of shift (day, evening, or night). Results: Residents were significantly less alert at the completion of the evening shift. Scores at the end of the night shift were significantly lower than the start of the night shift. Conclusions: Alertness software can be reliably integrated into the emergency department. Alertness was lower at the end of the evening shift and end of the night shift. This work could have positive implications on shift and task scheduling and potentially reduce errors in patient care by quantifying providers’ fatigue and identifying areas for countermeasures.