The Association of Anaesthetists of Great Britain & Ireland (AAGBI) has called for a change to the culture around night shift working and urged all anaesthetic departments and hospitals to provide vital rest facilities and to support the staff that need them.
The AAGBI 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 is the professional membership organisation for over 11,000 anaesthetists in the UK and Ireland.
It 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.
The Association has set out a 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.
They say that 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 survey by the Royal College of Anaesthetists has shown 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, junior doctors in an acute hospital specialty, such as anaesthesia, will work well over a year’s worth of hospital night shifts in the first ten years of their career. Consultants also work resident night shifts, and are subject to commonly interrupted nights’ sleep when they are on call.
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.
The AAGBI three-point plan is:
- 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.
- Roll out of a fatigue education programme informing doctors and their managers about fatigue and how they can reduce its risks.
- Defining the standards for adequate rest facilities and cultural attitudes towards rest in hospitals.