A 46-year-old man has been admitted to the hospital with diabetic ketoacidosis. He is given intravenous fluids and an insulin drip, and lab tests are scheduled. The on-call physician transfers the patient to the day shift physician in the morning, who comes an hour late owing to an emergency at his overnight moonlighting job. The patient's state and instructions to monitor electrolytes and compute his anion gap are included in the handoff information. The doctor does inpatient rounds and then his typical clinic outpatients in the afternoon, but he forgets to check the patient's anion gap. The patient's acidity worsens, necessitating intubation for respiratory distress. Which of the following is the most likely reason for this unfortunate outcome?

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Quizplus · Accepted Answer

Eductional Objective: Sleep deprivation is common among physicians and can have a profound effect on patient safety. Sleep science has demonstrated "dose-dependent" effects of sleep deprivation on physician cognitive performance and risk of medical errors. Impairments in cognitive performance and motor skills typically manifest after 17 hours of wakefulness and are comparable to those seen in an alcohol-intoxicated individual. Although the Accreditation Council for Graduate Medical Education has mandated limitations on resident work hours in response to patient safety concerns, extended work hours of attending physicians are unregulated. Physicians typically do a poor job of self-regulating their workload, often underestimate their cumulative sleep debt, and minimize its impact on their clinical skills. In this scenario, the physician has been working continuously for more than 24 hours; fatigue is the most likely contributor to his forgetting to check the patient's anion gap, which resulted in the adverse outcome.

A 46-Year-Old Man Has Been Admitted to the Hospital with Diabetic