References of "Berastegui, Pierre"
     in
Bookmark and Share    
Full Text
Peer Reviewed
See detailFatigue-related risk perception among emergency physicians working extended shifts.
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; Ghuysen, Alexandre ULiege et al

E-print/Working paper (in press)

There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern ... [more ▼]

There is a growing body of studies indicating that extended shift duration has an adverse effect on fatigue, consequently leading to reduced work performance and higher risk of accident. Following modern fatigue risk management systems (FRMS), acceptable performance could be maintained by the mobilization of appropriate mitigation strategies. However, the effective deployment of such strategies assume that workers are able to assess their own level of fatigue-related impairments. In this study, we sought to determine whether emergency physicians’ subjective feelings of sleepiness could provide accurate knowledge of actual fatigue-related impairments while working extended shifts. We conducted a prospective observational study with a within-subjects repeated measures component. We collected sleep logs, sleepiness ratings and reaction times on a Psychomotor Vigilance Task (PVT) at different time points during shifts. Our results show that the PVT is sensitive to sleep loss and fatigue, with a 10% increase in mean reaction time across the shift. Subjective sleepiness, however, showed no significant association with time since awakening and was not a significant predictor of PVT performance. Our results are consistent with experimental studies showing that individuals tend to underestimate fatigue-related impairments when sleep deprived or functioning under adverse circadian phase. The discrepancy between subjective sleepiness and actual fatigue-related impairments may give workers the illusion of being in control and hinder the deployment of mitigation strategies. Further research is needed to determine the relative weight of circadian phase shifting and cumulative sleep deprivation in the decline of self-knowledge in extended shifts. [less ▲]

Detailed reference viewed: 22 (3 ULiège)
Full Text
Peer Reviewed
See detailInformal fatigue-related risk management in the emergency department: a trade-off between doing well and feeling well?
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; Ghuysen, Alexandre ULiege et al

E-print/Working paper (in press)

The effect of shift work on health and safety has long been a concern of public authorities, and increasingly stringent directives have been issued over the past decades. However, there are evidences that ... [more ▼]

The effect of shift work on health and safety has long been a concern of public authorities, and increasingly stringent directives have been issued over the past decades. However, there are evidences that current directives still represent a hazard in some work settings by disturbing the sleep/wake regulation processes. Emergency physicians are known to be particularly vulnerable to sleep deprivation due to inconsistent shift rotation, extended duty periods and overnight calls. However, naturalistic studies have actually failed to systematically demonstrate that sleep deprivation is associated with poorer work performance in emergency physicians. The inconsistency of these results could reside in physicians’ ability to compensate for fatigue-related impairments. Our aim is to identify informal fatigue management strategies used by emergency physicians and to assess the efficiency in terms of fatigue, work performance and associated risks for physician burnout. We conducted a prospective longitudinal study with 28 emergency physicians for a total of 182 shifts. At enrolment, participants answered the Maslach Burnout Inventory and the Fatigue Management Survey. During shifts, we measured fatigue using the Psychomotor Vigilance Task and work performance using an adapted version of the Physician Achievement Review. Our results show that emergency physicians working at this public sector hospital use different types of compensatory strategies to manage fatigue-related risk, and that some of these strategies might result in a trade-off between work performance and occupational burnout. We propose further considerations for the implementation and follow-up of a fatigue risk management system in the emergency department. [less ▲]

Detailed reference viewed: 33 (3 ULiège)
Full Text
See detailLa gestion du risque associé à la fatigue : identification et évaluation de pratiques informelles
Berastegui, Pierre ULiege

Doctoral thesis (2019)

Les médecins urgentistes sont particulièrement à risque en matière de fatigue au travail en raison de périodes de veilles prolongées, d’un sommeil fragmenté et de conflits persistants entre l’horloge ... [more ▼]

Les médecins urgentistes sont particulièrement à risque en matière de fatigue au travail en raison de périodes de veilles prolongées, d’un sommeil fragmenté et de conflits persistants entre l’horloge biologique et l’horloge professionnelle (Alhola et al., 2007). Toutefois, les études en situation naturelle ne parviennent pas à démontrer que la privation de sommeil se traduit par une augmentation systématique des erreurs médicales (Gates et al., 2018; Weiss et al., 2016; Kramer, 2010). Nous postulons que l’absence de relation claire et systématique entre fatigue et performance médicale trouve son origine dans l’existence de mécanismes compensatoires visant à réduire ou à mitiger le risque associé à la fatigue. Premièrement, nous avons mené plusieurs focus group avec un total de 28 médecins urgentistes afin d’identifier les éventuelles stratégies de gestion du risque mobilisées de façon informelle. Deuxièmement, nous avons développé un sondage évaluant la fréquence d’utilisation des stratégies rapportées lors de la phase précédente. Enfin, nous avons une étude observationnelle prospective pour évaluer l’efficacité des stratégies rapportées sur base d’indicateurs relatifs à la fatigue, à la performance au travail et au burnout. Nos résultats montrent que les stratégies rapportées peuvent être qualifiées de stratégies de réduction (FRS) et de proofing (FPS). Le déploiement régulier de FRS a un effet bénéfique sur le niveau de fatigue des médecins sans coût associé pour l’individu en termes de burnout. Les FPS permettent aux médecins de maintenir un niveau acceptable de performance au détriment d’une usure émotionnelle susceptible de conduire au burnout. Nous discutons ces résultats à la lumière de l’hypothèse cognitivo-énergétique et proposons des perspectives en matière de gestion du risque associé à la fatigue en médecine d’urgence. [less ▲]

Detailed reference viewed: 30 (1 ULiège)
Full Text
Peer Reviewed
See detailFatigue‐related risk management in the emergency department: a focus‐group study
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; GHUYSEN, Alexandre ULiege et al

in Internal and Emergency Medicine (2018)

Fatigue has major implications on both patient safety and healthcare practitioner’s well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a ... [more ▼]

Fatigue has major implications on both patient safety and healthcare practitioner’s well-being. Traditionally, two approaches can be used to reduce fatigue-related risk: reducing the likelihood of a fatigued operator working (i.e. fatigue reduction), or reducing the likelihood that a fatigued operator will make an error (i.e. fatigue proofing). Recent progress mainly focussed on fatigue reduction strategies such as reducing work hours. Yet it has to be recognized that such approach has not wholly overcome the experience of fatigue. Our purpose is to investigate individual proofing and reduction strategies used by emergency physicians to manage fatigue-related risk. 25 emergency physicians were recruited for the study. Four focus groups were formed which consisted of an average of six individuals. Qualitative data were collected using a semi-structured discussion guide unfolding in two parts. First, the participants were asked to describe how on-the-job fatigue a ected their e ciency at work. A mind map was progressively drawn based upon the participants’ perceived effects of fatigue. Second, participants were asked to describe any strategies they personally used to cope with these effects. We used inductive qualitative content analysis to reveal content themes for both fatigue effects and strategies. Emergency physicians reported 28 fatigue effects, 12 reduction strategies and 21 proofing strategies. Content analysis yielded a further classification of proofing strategies into self-regulation, task re-allocation and error monitoring strategies. There is significant potential for the development of more formal processes based on physicians’ informal strategies. [less ▲]

Detailed reference viewed: 94 (14 ULiège)
Peer Reviewed
See detailEmergency Medical Services: When Fatigue Becomes The Norm.
Berastegui, Pierre ULiege; Jaspar, Mathieu ULiege; GHUYSEN, Alexandre ULiege et al

Conference (2017, June 27)

BACKROUND: Emergency Medical Services (EMS) routinely work at the very limit of their capacity due to growing emergency rooms visits and residents’ shortage. In this context, EMS workers are regularly ... [more ▼]

BACKROUND: Emergency Medical Services (EMS) routinely work at the very limit of their capacity due to growing emergency rooms visits and residents’ shortage. In this context, EMS workers are regularly asked to work more than 10 hours a day, on varying shifts and with short recuperation breaks. Two approaches can be used to reduce fatigue-related risk: reducing the likelihood a fatigued operator is working (i.e. fatigue reduction), or reducing the likelihood a fatigued operator will make an error (i.e. fatigue proofing). In Emergency Medical Services, formal risk control mainly focuses on reduction strategies such as reducing work hours while proofing strategies develops as an implicit element of the safety system. OBJECTIVE: Our purpose is to identify individual proofing and reduction strategies used by emergency residents and to investigate how they relate to fatigue, performance and patient safety indicators. METHODS: First, we conducted 4 focus-group sessions with a total of 25 EMS residents to elicit perceived consequences of fatigue and strategies used to cope with them. Focus group results were used to design a questionnaire assessing how often EMS residents personally used any of the strategies reported during sessions. Second, we administered the questionnaire to a larger sample and conducted a prospective observational study with a repeated within-subjects component. A total of 35 EMS residents participated in the study for a total of 200 shifts analyzed. We gathered sleep diaries, subjective sleepiness, reaction time, self-reported medical errors and performance ratings at different time point during both day and night shift using an android-based application. Sleep time and activity levels were confirmed using wrist actigraphy. DISCUSSION: We will discuss what can be drawn from our results in terms of individual and collective resilience processes with a focus on the potential for implementation of more formal processes at a system level.  [less ▲]

Detailed reference viewed: 49 (7 ULiège)
Peer Reviewed
See detailProofing & Reduction Strategies Used by Emergency Residents to Manage Fatigue-related Risk
Berastegui, Pierre ULiege; Ghuysen, Alexandre ULiege; Nyssen, Anne-Sophie ULiege

Poster (2016, July 29)

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the ... [more ▼]

Fatigue and sleep loss are typically associated with psychomotor and cognitive impairment resulting in poorer task performance. Most of these studies are conducted in controlled settings and involve the completion of experimental tasks. Only a few field studies involving exhausted residents have been conducted over the past decade, and they yielded to contradictory results (Ellman et al., 2004). One of the key factors that could be involved in the non-linear relationship between fatigue and performance in specific work context reside in the mobilization of Fatigue Proofing Strategies. FPS are adaptive and protective risk-reduction behaviors that improve the resilience of a system of work (Dawson et al., 2012). In this study, we aimed to identify and classify proofing strategies mobilized by EMS residents using an inductive content analysis approach. EMS residents reported a range of strategies for reducing subjective level of sleepiness (reduction strategies, n=15) or managing its consequences (proofing strategies, n=17). Content analysis yielded to three sub-categories of proofing strategies: Behavioral Compensation (n=8), Error’s Opportunity Reduction (n=5) and Error’s Consequences Mitigation (n=4). Our results show that EMS residents use both types of strategies although none of the proofing strategies were part of their training program. Despite the current informal use, there is significant potential for implementation of more formal processes. [less ▲]

Detailed reference viewed: 51 (10 ULiège)
Peer Reviewed
See detailIs system resilience maintained at the expense of individual resilience?
Nyssen, Anne-Sophie ULiege; Berastegui, Pierre ULiege

in Braithwaite, Jeffrey; Wears, Robert; Hollnagel, Erik (Eds.) Resilient Health Care III: Reconciling Work-As-Imagined and Work-As-Done (2016)

Detailed reference viewed: 67 (15 ULiège)
Peer Reviewed
See detailHow novice and expert drivers adjust their driving behavior when they feel drowsy?
Berastegui, Pierre ULiege; Piette, Christine; François, Clémentine ULiege et al

Poster (2015, July 29)

This paper aims to explore adaptive behaviors developed by drivers to prevent drowsiness. Specifically, we postulate that driving expertise is associated with better drowsiness awareness, allowing experts ... [more ▼]

This paper aims to explore adaptive behaviors developed by drivers to prevent drowsiness. Specifically, we postulate that driving expertise is associated with better drowsiness awareness, allowing experts to adequately adjust their driving behaviors when they feel drowsy. The present study was carried on a high-fidelity driving simulator coupled with an innovative system allowing objective sleepiness assessment based on EEG and Eye-tracking data. The Karolinska Sleepiness Scale was used to evaluate subjective drowsiness. The ratio between objective and subjective assessments gave an indicator of drowsiness awareness. Standard Deviation of Lateral Position (SDLP) was used as a measure of performance while driving speed and ocular fixations were recorded in order to highlight adaptive behaviors. 16 subjects were recruited from general population and categorized in two groups of expertise based on the Belgian Institute for Road Safety’s criteria. Our results show that expert drivers show better drowsiness awareness than novices and mobilize speed increasing and vigilance reallocation strategies to maintain satisfactory level of drowsiness. [less ▲]

Detailed reference viewed: 91 (38 ULiège)
See detailSomnoTraq
Berastegui, Pierre ULiege; Antoine, Loïc

Software (2015)

SomnoTraq is an android-based application aiming to track fatigue-related risk over time among healthcare practitioners. This application is composed of several modules: sleep/work diary, error reporting ... [more ▼]

SomnoTraq is an android-based application aiming to track fatigue-related risk over time among healthcare practitioners. This application is composed of several modules: sleep/work diary, error reporting system, fatigue scale (e.g. Karolinska Sleepiness Scale) and vigilance test (e.g. Psychomotor Vigilance Test). SomnoTraq allows the researcher to conduct longitudinal studies involving specific modules at different times. Data are stored on the user’s phone as a CSV file that is readily importable to any device for statistical analysis. The main advantage of this application resides in its ability to collect multiple indicators of fatigue-related risk within a short period of time (i.e. approximately 6 minutes). This asset makes SomnoTraq particularly suitable for on-the-job investigations characterized by significant time pressure. [less ▲]

Detailed reference viewed: 51 (26 ULiège)