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!
