Karim Tazarourte

Optimizing sleep health in healthcare professionals is a challenge, as misalignment between endogenous circadian rhythms and exogenous work schedules undermines recovery, well‐being, and performance. This study evaluated a tailored recovery intervention based on cognitive‐behavioural approaches for insomnia designed to support recovery to rotating night shifts. In a randomized controlled trial (REST), 72 emergency healthcare professionals were randomized to intervention or control. The intervention combined personalized sleep–wake feedback with stress management techniques. Sleep–wake rhythms were monitored via actigraphy for 3 weeks before and 1 week after the intervention. Outcomes included objective sleep duration, self‐reported sleepiness, insomnia severity, and subjective sleep quality, measured using the Epworth Sleepiness Scale, Insomnia Severity Index, and Leeds Sleep Evaluation Questionnaire. Fifty‐nine participants (28 intervention, 31 control) were included in the primary analyses. Even on free nights, average nocturnal sleep duration was 6 h and 21 min, below recommended levels for adults. Compared with controls, intervention participants increased nocturnal time in bed by 37 min, 95% CI [13, 62], p = 0.003, and total sleep time by 23 min, 95% CI [4, 42], p = 0.019. Perceived sleep quality also improved for the intervention group t(55) = −7.91, p < 0.001, d = 2.06, 95% CI [1.42, 2.70], and insomnia symptoms decreased ( β = −2.23, 95% CI [−4.26, −0.21], p = 0.031). These findings suggest that structured occupational recovery programs can enhance sleep health and facilitate recovery across rotating night work schedules. Integrating such interventions into training may reduce burnout, improve safety, and support workforce sustainability.

La prise en charge des urgences vitales préhospitalières en France, est du ressort des SMUR sous l’autorité des SAMU, seuls responsables de l’organisation des soins, du lieu de survenue jusqu’à l’hôpital. L’accessibilité de la population aux équipes médicales des SMUR n’avait jamais été évaluée. Au travers de l’analyse prospective d’une cohorte de 500 patients traumatisés crâniens graves, pris en charge par les SAMU/SMUR en Ile de France, l’apport d’outils SIG a permis d’identifier les caractéristiques d’accessibilité et de disponibilité de l’organisation territoriale des SMUR franciliens. Des territoires ont été identifiés potentiellement à risque, en raison d’une accessibilité des moyens SMUR supérieure à 30 minutes. Cependant, le critère d’accessibilité pris isolément, masque de fortes inégalités dans l’organisation territoriale des SMUR. La disponibilité d’un SMUR est un critère essentiel, rarement évalué. La prise en charge du traumatisme crânien grave illustre parfaitement la situation. La réflexion géographique et l’utilisation des outils SIG permettent de pouvoir évaluer et visualiser objectivement les atouts et faiblesses de l’organisation territoriale d’un système de santé et de proposer des modèles d’organisation pertinents.

Background: Human error is a leading cause of preventable harm in clinical care, driven by factors such as cognitive overload and staff turnover. While customisable digital cognitive aids (cDCAs) have emerged as real-time protocol-tailored support, a framework to quantify their total impact on human error and its fundamental limits has been lacking. Methods: We conducted a pooled analysis of five randomised high-fidelity simulation trials with consistent methodologies, including 370 healthcare professionals across diverse clinical settings and levels of experience. Using bootstrap resampling, we modelled the distributions of technical and non-technical skills (TS and NTS) to quantify the impact of cDCAs on clinical competence and on Total Human Error (THE)—defined as the sum of systematic deviation from standards (bias ² ) and inter-individual variability (variance). Findings: The use of cDCAs reduced THE by 75% in a novice user context. This effect was driven by concurrent, drastic reductions in systematic deviation from standards ( bias ² : 328.1 vs 1377.1) and inter-individual variability ( variance : 124.3 vs 210.0). This was reflected in significant improvements in both technical (81.9±0.8 vs 62.9±1.0, presidual error threshold , quantifying an empirical upper bound of ∼25% for what we define as Irreducible Human Error (IHE). Interpretation: By reducing both systematic bias and performance variability, cDCAs demonstrably harmonise clinical practices and enhance competence robustness. Our analysis provides the first empirical framework to quantify this beneficial effect, revealing in turn a ∼25% residual error that delineates the fundamental limits of performance enhancement achievable via procedural workflow support. We posit this threshold serves as an empirical upper bound for Irreducible Human Error (IHE)—errors arising not from procedural flaws but from higher-order cognitive or interpersonal factors. Establishing IHE as a new benchmark for patient safety thus provides foundational evidence for a model of augmented practice, where complementary innovations such as AI may be required to move beyond procedural support, augment clinical judgement, and uphold human-centred care. Research in Context: Evidence before this study: Cognitive support has long been used to mitigate human error in high-stakes environments. ‘Traditional’ cognitive support tools (e.g., paper checklists) improve adherence to technical protocols during medical crises, but their impact on non-technical skills—such as communication and decision-making—is limited and their clinical adoption remains low. Early digital aids largely replicated these static tools, often lacking the ergonomic integration needed for real-time clinical use and failing to leverage the full potential of digital platforms. Consequently, no prior study had systematically assessed the impact of customisable digital cognitive aids (cDCAs) on both technical and non-technical skills across diverse clinical domains to establish their overall efficiency and robustness . Furthermore, no prior study has established a comprehensive framework for evaluating their effects on ‘Total Human Error’ (THE)—encompassing both bias and variability in practice—or introduced a measurable threshold for an ‘Irreducible Human Error’ (IHE) in clinical care. What this study adds: This study is the first to quantify competence—defined as the integration of procedural proficiency (TS) and cognitive-behavioural dimensions (NTS)—and measured the impact of cDCAs on TS and NTS performance and variability, across multiple clinical settings and experience levels. We pooled five randomised controlled trials with consistent methodologies and used a resampling technique (bootstrap analysis), which allowed us to model distributions of performance and assess robustness across diverse professional backgrounds. Unlike traditional digital checklists, which often impose cognitive effort or disrupt team workflows, cDCAs are adaptive interfaces, integrating seamlessly into decision-making with minimal cognitive load. Our work systematically quantifies clinical competence and THE across both TS and NTS. We demonstrated that cDCAs significantly reduced systematic bias—defined as deviation from expected standards—along with inter-individual and inter-situation variability, thereby harmonising clinical practices and improving reliability—even in high-stakes scenarios. The reduction in inter-situation variability is particularly relevant, as it strengthens the robustness of clinical care delivery, ensuring consistent performance across diverse settings. By defining and quantifying IHE, we establish a benchmark for understanding the limits of human performance—beyond which cognitive aids alone may be insufficient. Implications of all the available evidence: Integrating customisable, ergonomically optimised cDCAs into routine clinical workflows provides a scalable solution to reduce THE by harmonising practices and improving adherence to care standards. This is particularly valuable in resource-limited settings, where cDCAs could help exchange expertise. By establishing IHE as a measurable threshold, this study provides a foundation for further innovations in cognitive support. While current cDCAs provide substantial reductions in THE, these findings raise the question of whether AI could further complement cognitive aids while preserving human expertise at the core of decision-making. Future research should explore how AI-enhanced cognitive aids might ethically and transparently address residual human error, ensuring these technologies reinforce—rather than undermine—the foundational principles of trust, accountability, and patient-centred care. Finally, beyond individual performance, cDCAs may contribute to global equity by promoting robust, harmonised care and enhancing knowledge retention and application across healthcare systems. In an interconnected world, where no system operates in isolation, ensuring safe, high-quality care on a global scale is imperative.

Introduction The decisions of withholding or withdrawing life-sustaining treatments are difficult to make in the context of emergency departments (EDs) because most patients are unable to communicate. Relatives are thus asked to participate in the decision‐making process, although they are unprepared to face such situations. We therefore aimed to develop a standardised intervention for announcing decisions of withholding or withdrawing life-sustaining treatments in EDs and assess the efficacy of the intervention on the stress of relatives. Methods and analysis The DISCUSS trial is a multicentre stepped-wedge cluster randomised study and will be conducted at nine EDs in France. A standardised intervention based on human simulation will be codesigned with partner families and implemented at three levels: the relatives, the healthcare professionals (HCP) and the EDs. The intervention will be compared with a control based on treatment as usual. A total of 538 families are planned to be included: 269 in the intervention group and 269 in the control group. The primary endpoint will be the symptoms of post-traumatic stress disorder (PTSD) at 90 days. The secondary endpoints will be symptoms of PTSD at 7 and 30 days, diagnosis of PTSD at 90 days and anxiety and depression scores at 7, 30 and 90 days. Satisfaction regarding the training, the assertiveness in communication and real-life stress of HCPs will be measured at 90 days. Ethics and dissemination This study was approved by the ethics committee Est III from Nancy and the French national data protection authority. All relatives and HCPs will be informed regarding the study objectives and data confidentiality. Written informed consent will be obtained from participants, as required by French law for this study type. The results from this study will be disseminated at conferences and in a peer-reviewed journal. Trial registration number NCT06071078.

Study Objective: The present study is aimed at providing an assessment of the changes in burnout, job strain, isostrain, sleepiness, and fatigue levels over time and identifying factors associated with these symptoms among healthcare workers in French emergency departments (EDs).Method: We conducted a prospective, multicenter study in four EDs and an emergency medical service. Participants completed questionnaires at inclusion and at 90 days to assess burnout, job strain, isostrain, sleepiness, and fatigue.Results: A total of 211 respondents (43.5%) completed the questionnaires at inclusion. At the beginning of the study, 84 (40.8%) participants presented symptoms of burnout, 86 (43.2%) had symptoms of job strain, and 58 (29.4%) of isostrain. Forty‐two (20.1%) healthcare workers presented symptoms of sleepiness, and 8 (3.8%) had symptoms of fatigue. We found that symptoms of burnout were more frequent for healthcare workers with a previous psychiatric history (55.3% vs. 39.1%, p = 0.02) and were lower among participants who had at least one dependent child (33.1% vs. 48.3%, p = 0.013). Symptoms of job strain were higher among administrative staff compared to physicians (55.6% vs. 28.7%, p = 0.01) and among healthcare workers with managerial responsibilities compared to those without (45.6% vs. 28.8%, p = 0.015). Symptoms of isostrain were higher among administrative staff (42.3%) compared to paramedics (34.1%) and physicians (19.8%, p = 0.026).Conclusion: We identified that potential factors associated with the emergence of symptoms of burnout and job strain are suggested, underlining several areas of improvement for the prevention against mental health disorders in the specific population of ED healthcare workers.Trial Registration: ClinicalTrials.gov identifier: NCT04383886.

Cannabis use frequently starts during adolescence and young adulthood and can induce psychosocial and health consequences. Young people constitute hard-to-reach populations. Emergency departments could constitute a key care setting to identify cannabis use and its consequences among young people. To estimate the rate of cannabis use in the 16- to 25-year-old population visiting the emergency department for any reason and to assess the psychosocial factors associated with cannabis use. This was a cross-sectional study among young people who attended the emergency department, over 5-months. Data were sociodemographic characteristics, self-administered questionnaires for problematic substance use screening, and urine drug screening samples. They were classified in the cannabis use (CU) group if they had a positive urine screen or reported cannabis use in the previous month. Characteristics of individuals in the CU and non-CU groups were compared. A total of 460 participants were included, of whom 105 were in the CU group. Cannabis users were more likely to be male (aOR = 1.85; [1.18-2.90]), to be unemployed (aOR = 1.77; [1.03-3.04]), to have a lower mental health status score (aOR = 0. 82; [0.75-0.90]), to report a history of sexual abuse (aOR = 2.99; [1.70-5.25]), and to have a positive AUDIT screen (aOR = 4.23; [2.61-6.86]). The emergency department is a primary care setting for young people, which is conducive to screening for substance use. Cannabis users can be assessed and referred to adapt their treatment, given their lack of adherence to the traditional addictology care system.

This study aims to describe the use of patient partnership, as defined by the Montreal Model, in emergency departments (EDs) in France and report the perception of patient partnership from both the practitioner and patient perspectives. This cross-sectional study was conducted between July 2020 and October 2020. First, a survey was sent to 146 heads of EDs in both teaching hospitals and non-teaching hospitals in France to assess the current practices in terms of patient partnership in service organization, research, and teaching. The perceived barriers and facilitators of the implementation of such an approach were also recorded. Then, semi-structured telephone interviews were carried out with patients involved in a service re-organization project. A total of 48 answers (response rate 32.9%) to the survey were received; 33.3% of respondents involved patients in projects relating to service re-organization, 20.8% involved patients in teaching projects, and 4.2% in research projects. Overall, 60.4% of the respondents were willing to involve patients in re-organization or teaching projects. The main barriers mentioned for establishing patient partnership were difficulties regarding patient recruitment and lack of time. The main advantages mentioned were the improvement in patient/caregiver relationship and new ideas to improve healthcare. When interviewed, patients mentioned the desire to improve healthcare and the necessity to involve people with different profiles and backgrounds. A too important personal commitment was the most frequently raised barrier to their engagement. All the patients recognized their positive role, and more generally, the positive role of patient engagement in service re-organization. Although this preliminary study indicates a rather positive perception of patient partnership among heads of EDs in France and partner patients, this approach is still not widely applied in practice.