The effect of blue-enriched lighting on medical error rate in a university hospital intensive care unit

ABSTRACT Background Fatigue related errors that occur during patient care impose a tremendous socioeconomic impact on the healthcare system. Blue-enriched light has been shown to promote alertness and attention. The present study tested whether blue-enriched light can help to reduce medical errors in a university hospital adult intensive care unit (ICU). Methods In this interventional study, a blue-enriched white light emitting diode was used to enhance traditional fluorescent light at the nurse workstation and common areas in the ICU. Medical errors were identified retrospectively using an established two-step surveillance process; suspected incidents of potential errors detected on nurse chart review were subsequently reviewed by two physicians blinded to lighting conditions, who made final classifications. Error rates were compared between the pre-intervention fluorescent vs. post-intervention blue-enriched lighting conditions using Poisson regression. Results The study included a total of 1,073 ICU admissions, 522 under traditional and 551 under interventional lighting (age range 17 – 97 years, mean age ± SD, 58.5 ± 15.8). We did not find a difference in overall medical error rate (harmful and non-harmful) pre- vs. post-intervention, 45.5 vs. 42.7 per 1000 patient-days [rate ratio: 0.94, (95% CI: 0.71-1.23), p=0.64]. Conclusions Interventional lighting did not have an effect on overall medical error rate. The study was likely underpowered to detect the 25% error reduction predicted. Future studies are required that are powered to assess more modest effects for lighting to reduce the risk of fatigue-related medical errors, and errors of differing severity.