Medical errors more severe during daylight saving time, study suggests

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Those lobbying to ditch the “spring forward” clock-changing ritual have another reason to hate the time switch: New research suggests people are more likely to be a victim of a major medical error during the months of daylight saving time.

Researchers who parsed nearly 300,000 U.S. malpractice claims settled over the past three decades found the incidence and seeming severity of medical errors appeared higher during the seven to eight months of daylight saving time (DST) compared to standard time months.

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Payouts for medical malpractice were also higher. Sleep-deprived judges tend to be more punishing, less forgiving, the study suggests.

“The mild sleep loss and circadian misalignment associated with DST may influence incidence of medical errors and decisions on medical malpractice both acutely and chronically,” researchers reported this week in the Journal of Clinical Sleep Medicine.

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Most clocks in Canada will go forward one hour at 2 a.m. Sunday, a seasonal change the American Academy of Sleep Medicine, among other scientific bodies, would prefer to see abolished. People lose not just an hour’s sleep. The change to DST has been associated with an increased risk of car crashes, a modest increase in heart attacks, an uptick in strokes in the first two days after the switch, and an increase in hospital admissions for atrial fibrillation.

A 2021 study found human errors resulting in medical harm, like medication mix-ups, increased by nearly 20 per cent in the first few days following the change to daylight saving time.

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For the new study, researchers analyzed data from 288,432 malpractice cases.

They didn’t see an acute or immediate effect of the time change on the severity of medical “incidents” when they compared claims for one week before and one week after the spring transition. But judgements for final financial compensation for medical errors were higher than expected when decided during DST months.

To investigate the chronic effects of DST months, the team compared medical malpractice incidents and payment decisions averaged across the seven to eight sustained months of DST, versus the four to five months of standard time, using states that remained on permanent standard time: Arizona, Hawaii and (until April 2006) Indiana.

Both the severity of medical malpractice incidents and the payouts were higher during the months of DST.

The finding “definitely needs additional investigation and confirmation,” said principal investigator Michael Scullin, an associate professor of psychology and neuroscience at Baylor University in Waco, Tex.

“But frankly, it fits with what we’re seeing in the literature,” he said. People are more likely to make mistakes, and be more emotionally reactive, when their sleep-wake cycle, their circadian alignment, has been thrown off.

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In an earlier study Scullin and colleagues published in 2019, volunteers who had been mildly sleep restricted (6.2 hours of sleep per night) for four consecutive nights were four times more likely than the well-rested (7.7 hours/night) to want to dole out the maximum punishment to doctors, and the maximum financial compensation to patients, after reading a series of vignettes describing different medical errors, such as a surgeon who forgot to remove all surgical instruments from a patient’s  body.

The literature on sleep and emotional processes is vast, Scullin said. The sleep-restricted tend to be more emotionally impulsive. When bad things happen and people have been hurt, sleep-deprived judges might have stronger emotional reactions, and less empathy for the person who made the mistake. “If you’re going to have an emotional reaction, even if it’s a subtle reaction, if you’re going to have any type of impulsivity, it’s going to lean toward the more negative in this context,” Scullin said.

It fits with criminal cases: judges tend to render longer sentences following the spring DST change.

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Why medical errors appeared to be more severe during daylight saving time — based on the the more generous payouts — isn’t entirely clear. In a media statement, first author Chenlu Gao, a postdoctoral research fellow at the Massachusetts General Hospital, said it’s possible “that several months of living under daylight saving time leads to accrued circadian misalignment.”

Circadian rhythms are the body’s natural 24-hour cycles that regulate multiple processes in the body, like appetite, mood and sleep. With circadian misalignment, the body’s internal clock isn’t matched to the external environment. A master clock in the brain — the suprachiasmatic nucleus — regulates mini clocks in the body’s tissues and organs. “There are about a trillion of them, one in every single cell in our body,” Scullin said.

The master clock knows when to begin firing and when to stop firing, based on light. When to feel sleepy, and when to feel alert. That top-down machinery is central to optimize daily functioning.

“If there is a little bit of misalignment, your body doesn’t quite know when it should be feeling alert,” Scullin said, which can be problematic in decision-making situations, like treating patients. Some work suggests diagnostic errors are more common during daylight saving time.

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Even a subtle bit of sleep loss can matter; the brain doesn’t operate as efficiently as it should. During daylight saving time months, “there is this very mild, but potentially cumulative sleep debt,” Scullin said.

With lighter evenings, people generally go to bed later than standard time, though most have a set morning schedule and can’t sleep in.

Ontario passed legislation in 2020 that would make daylight saving time permanent. But the American Academy of Sleep Medicine advocates for year-round standard time, and sleep researchers have warned 12 months of DST could lead to chronic social jetlag, Scullin and his co-authors wrote.

Details about the types of mistakes made, and the experience of those who made them, were kept private in the malpractice claims database, to ensure legal confidentiality. And the study doesn’t prove causation, just an association.

But as long as the seasonal time shift remains, people should be doing their best to prepare for it, Scullin said. Rather than trying to “just wing it through the week,” he recommends going to bed 15 minutes earlier than normal Friday night, 15 minutes earlier Saturday and 15 minutes earlier a third night.

“Allow your body to adjust more gradually,” he said.

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