A national survey of out‐of‐hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland

McClelland, Laura E.; Plunkett, Emma; McCrossan, Roopa; Ferguson, K.; Fraser, James; Gildersleve, C.; Holland, Jennifer; Lomas, John-Paul; Redfern, N.; Pandit, J. J.

doi:10.1111/anae.14819

Cited by 37 publications

(35 citation statements)

References 15 publications

(18 reference statements)

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“…Multiple studies among doctors found that prevalence of fatigue range from 28% to 91%. [12][13][14][15][16][17][18] The majority of them were experiencing high and frequent fatigue 17 18 with low and moderate intershift recovery. 19 These findings are not surprising as a doctor's Strengths and limitations of this study ► Multicentre study involving seven core clinical disciplines from seven tertiary public hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

et al. 2020

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ObjectivesThis paper aims to estimate the level of acute fatigue, chronic fatigue and intershift recovery among doctors working at public hospitals in Malaysia and determine their inter-relationship and their association with work-related activities during non-work time.DesignCross-sectional.SettingSeven core clinical disciplines from seven tertiary public hospitals in Malaysia.ParticipantsStudy was conducted among 330 randomly-sampled doctors. Response rate was 80.61% (n=266).ResultsThe mean score of acute fatigue, chronic fatigue and intershift recovery were 68.51 (SD=16.549), 54.60 (SD=21.259) and 37.29 (SD=19.540), respectively. All these scores were out of 100 points each. Acute and chronic fatigue were correlated (r=0.663), and both were negatively correlated with intershift recovery (r=−0.704 and r=−0.670, respectively). Among the work-related activities done during non-work time, work-related ruminations dominated both the more frequent activities and the association with poorer fatigue and recovery outcomes. Rumination on being scolded/violated was found to be positively associated with both acute fatigue (adjusted regression coefficient (Adj.b)=2.190, 95% CI=1.139 to 3.240) and chronic fatigue (Adj.b=5.089, 95% CI=3.876 to 6.303), and negatively associated with recovery (Adj.b=−3.316, 95% CI=–4.516 to –2.117). Doing work task at workplace or attending extra work-related activities such as locum and attending training were found to have negative associations with fatigue and positive associations with recovery. Nevertheless, doing work-related activities at home was positively associated with acute fatigue. In terms of communication, it was found that face-to-face conversation with partner did associate with higher recovery but virtual conversation with partner associated with higher acute fatigue and lower recovery.ConclusionsWork-related ruminations during non-work time were common and associated with poor fatigue and recovery outcomes while overt work activities done at workplace during non-work time were associated with better fatigue and recovery levels. There is a need for future studies with design that allow causal inference to address these relationships.

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Section: Introductionmentioning

confidence: 99%

“…Despite numerous studies related to work hours and fatigue, [12][13][14][15][16][17][18][19][20][21] there is limited study specifically on acute fatigue, chronic fatigue and intershift recovery as well as their association with work-related activities during non-work time among doctors. To date, no similar study has been done in Malaysia.…”

Section: Introductionmentioning

confidence: 99%

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

et al. 2020

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“…More than 300 million people need to undergo surgery each year all over the world [1], and over 70% of them got no access to safe, affordable anesthesia or surgical care [2], and the severe de ciency of global anesthesia workforce was one of the causes of this phenomenon [3]. The lack of rst-line doctors also led to work overload and more night shifts, which disturbed the biological rhythm and caused major stress and depression [4][5][6][7]. Exposed to long working hours, work overload, chronic sleep deprivation, need for sustained vigilance, continuous noise pollution and even the patients' halitosis [8], and contamination risk of COVID-19 [9], anesthesiologists are forced to bear huge job stress [10][11][12][13], which further cause anxiety, depression, sleep disturbances, memory and attention disturbance, nightmare, need for medication and so on [14,15].…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality as a Measure to Reduce Stress of Night-Shift Anesthesiologists: Study Protocol for a Cross-Over Design Trial

Chen¹,

Chen²,

Shen³

et al. 2020

Preprint

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Background: Because of the severe deficiency of global anesthesia workforce, anesthesiologists are forced to face work overload and more night shifts, which can disturbe the biological rhythm and cause major stress and depression, causing negative even devastating outcomes for both themselves and the patients eventually. Virtual reality (VR) as a new measure to reduce stress and pain for patients, has been widely used in biomedical fields.The purpose of the study is to evaluate the potential effectiveness of VR technology in reducing the stress of night-shift anesthesiologists.Methods: In this randomized controlled, cross-over design, single-center clinical trial, a total of 30 anesthesiologists are enrolled and randomized in a 1:1 allocation to either the VR immersion group (intervention group) or the routine night-shift group (control group) with a washout of 1 week. Anesthesiologists in the intervention group undergo VR immersion for twice while anesthesiologists in the control group will not watch VR videos during the night shift. The primary outcome is the difference between two groups about the score of NASA-TLX scale. Secondary outcomes include the score of CPSS, VAS and MFI-20 scales, satisfaction degree of the participants, heart rate (HR), blood pressure (BP), the incidence of arrhythmia as well as incidence of chest tightness, headache, palpitations.Discussion: It is unknown whether the use of VR technology during the night shift can reduce the stress of night-shift anesthesiologists. With the widely use of VR technology, a positive result of the trial could spur the hospital to apply the technology to reduce the stress of night shift doctors in every department as well as offer a relatively relaxed working environment.Trial registration: ChiCTR2000031025 on March 21, 2020.

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“…In this issue, McClelland et al. provide data on self‐reported fatigue in a large cohort (n = 3847) of anaesthetic consultants and paediatric intensivists in the UK and Republic of Ireland . Although much has been written on fatigue in junior doctors and trainees, this is one of the first studies to report systematically on working time arrangements and self‐reported fatigue and well‐being in senior medical staff.…”

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confidence: 99%

Fatigue management in healthcare: it is a risky business

Dawson

Thomas

2019

Anaesthesia

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management systems (FRMS) have recently been adopted in several jurisdictions including Australia [11] and Canada [12]. Using these guidance materials, organisations are provided with scientifically and legally defensible methodologies for measuring and managing fatigue risk based on general principles of safety management [13,14].What differentiates these approaches is their understanding that fatigue is often unavoidable and that fundamentally different approaches to fatigue risk management need to be adopted in healthcare, and in particular:1 Working time arrangements often need to be tailored to the local work group to ensure cost effective operational outcomes 2 Compliance with working time arrangements is a poor substitute for measuring and managing fatigue-related risk.3 Fatigue-related risk is highly variable and will reflect many factors other than the working time arrangement.Call-out patterns (i.e. frequencies and durations), typeof-work, work-load intensity, level of supervision, level of team support and individual experience can also profoundly influence fatigue-related risk at the local work group level. All of these should be considered in measuring and managing the level of risk. 4 Prior sleep, wakefulness and time-of-day are better predictors of fatigue than the working time arrangements and can be used to estimate fatigue likelihood more accurately at the individual and group level [13, 15]. 5 Measuring and monitoring obtained sleep or sleepiness is often a more effective way to quantify and control fatigue-related risk 6 The likelihood and consequence (i.e. risk) of a fatiguerelated error can be substantially reduced by identifying typical fatigue-related errors in the work place and redesigning work flows to either prevent such errors or improve the likelihood of detection and correction [16, 17]. Most FRMS focus on the six points outlined above in order to identify and manage fatigue-related risk more effectively. The advantage of these approaches is that they enable organisations to acknowledge, measure and mitigate fatigue-related risk without compromising doctor or patient health and safety. Most importantly, they provide a clear pathway on how to manage a risk generally allocated to the 'too hard' basket. Although it may not always result in less fatigue, it will significantly reduce the risks associated with fatigue and ensure we minimise the modifiable risks to doctors and their patients. This may well help significantly reduce the likelihood of adverse medical events and help reduce some of the negative effects of fatigue on doctors and their families.And the best thing, we can start implementing a fatigue risk management system tomorrow; changing the roster will take much, much longer!

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A national survey of out‐of‐hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland

Cited by 37 publications

References 15 publications

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

Fatigue and recovery among Malaysian doctors: the role of work-related activities during non-work time

Virtual Reality as a Measure to Reduce Stress of Night-Shift Anesthesiologists: Study Protocol for a Cross-Over Design Trial

Fatigue management in healthcare: it is a risky business

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