Current and future directions in clinical fatigue management : an update for emergency medicine practitioners

Physicians worldwide are working round the clock to meet the demandsof healthcare systems, especially in acute medical settings such as EDs.Demanding shift work schedules cause fatigue and thus deterioration inmood and motor performance. This article explores the effects of sleep deprivation, focusing on cognition, executive decision-making and theimplications for clinical care. Humans are capable of functioning and even adapting to sleep restriction; however, clinicians should be aware of pitfalls and absolute minimums for sleep. Fatigue management training shows promise in enhancing safety in aviation and might have a role in medical shift work. Strategic napping improves performance during night shift in the ED, but does not fully negate fatigue. Drugs offer limited benefit for performance under sleep-deprived conditions, and whenever possible, sleep and/or strategic napping takes precedence.