On World Sleep Day, which highlights the importance of getting adequate sleep, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) set out its three-point plan to address the culture surrounding doctor fatigue in hospitals and tackle the problem of excessive fatigue, which is known to impair decision making, with consequences for both doctors and their patients.
Fatigue at the end of night shifts is of particular concern, with the tragic reports of doctors who have died in car accidents, having fallen asleep at the wheel on their commute home following a busy night shift. A RCoA morale and welfare survey also shows that 85% of junior anaesthetists are at high risk of burnout; fatigue is known to be a risk factor for this.
According to the AAGBI, a junior doctor in an acute hospital specialty, such as anaesthesia, will work well over a year’s worth of hospital night shifts in the first ten 10 years of their career. Consultants also work resident night shifts, and are subject to commonly interrupted nights’ sleep when they are on call. The Association is calling on all anaesthetic departments and hospitals to provide vital rest facilities and to support the staff that need them, and points to the examples of other industries with a responsibility for public safety, such as pilots or HGV drivers, where rest breaks are mandatory and naps are encouraged during night time working.
The AAGBI believes it is time for healthcare professions and NHS managers to acknowledge that working at night is not the same as working in the day, and that for the sake of patient safety, steps must be taken by all parties to manage night working safely. Limiting working hours is a positive step to reduce fatigue, says the Association, but it cannot overcome the powerful biological drive that requires humans to sleep at night. Unfortunately, as working patterns changed, many hospitals removed staff rest rooms that provided facilities for staff to take an important restorative nap during a quiet moment at night. Through a fatigue task group with partners including the RCoA, the AAGBI has devised the following 3-point plan:
1. Support publication of a national survey about junior doctor fatigue, covering accessibility of hospital rest facilities, commuting after working night shifts and the impact of fatigue on physical and psychological health.
2. Roll out of a fatigue education programme informing doctors and their managers about fatigue and how they can reduce its risks.
3. Defining the standards for adequate rest facilities and cultural attitudes towards rest in hospitals.
"World Sleep Day celebrates the importance of sleep. Lack of adequate sleep and the consequent fatigue is harmful to both doctors and their patients; the AAGBI’s work intends to address this issue. Our overarching aim is to change the culture around fatigue" said Emma Plunkett, Group of Anaesthetists in Training (GAT) Committee Chair, AAGBI.