The effects of fatigue on trainees in anaesthesia

McClelland, L. et al. | A national survey of the effects of fatigue on trainees in anaesthesia in the UK | Anaesthesia |2017; 72: 1069–77

Introduction

Long shifts remain a major feature of working life for trainees in anaesthesia. Over the past 10 years, there has been an increase in awareness and understanding of the potential effects of fatigue on both the doctor and the patient. Despite the introduction of the European Working Time Directive into UK law, reducing the maximum hours worked by junior doctors, there is evidence that problems with inadequate rest and fatigue persist.

Methods

These authors conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK.

Results

A response rate of 59% was achieved, with data from 100% of NHS trusts. The results suggested that fatigue remains prevalent among junior anaesthetists, with 73.6% saying that it has effects on physical health, 71.2% that it affects psychological wellbeing and 67.9% that personal relationships are affected. The most problematic factor remains night shift work, with many respondents commenting on the absence of breaks, inadequate rest facilities and 57.0% stating that they had experienced an accident or near-miss when travelling home from night shifts.

Conclusions

The authors discuss potential explanations for the results, and present a plan to address the issues raised by their survey, aiming to change the culture around fatigue for the better.

Full article available via Wiley online Library

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A survey of acute pain services in the UK

The organisational state of inpatient pain management in UK hospitals is difficult to determine. We sent an electronic questionnaire to 209 acute pain service leads throughout the UK | Anaesthesia

Questions were about staffing and service provision. We received 141 responses (67%); 47% of all UK hospitals.

Each service was responsible for a median (IQR [range]) of 566 (400–839 [120–2800]) beds. Each acute pain specialist nurse was responsible for 299 (238–534 [70–1923]) beds. The mean (SD) number of consultant hours per week was 5.54 (4.62), delivered by a median of 1.0 (1.0–2.5 [0.2–7.0]) consultant. Overnight cover was provided by 20 (15%) acute pain services, and weekend cover by 39 (29%).

Acute pain services commonly (in 50 (35%) hospitals) had roles in addition to acute pain management. Most teams (105, (77%)) reviewed medical patients and patients with chronic pain (in 131, (96%) teams). Half of the services (56, (49%)), reported that they were part of an integrated acute and chronic pain service, however, 83 (59%) did not have any members who work in chronic pain clinics. The majority (79, (70%)) were able to access a nominated chronic pain consultant for advice.

Provision of acute pain services throughout the UK is highly variable. The majority do not meet core UK standards.

Full reference: Rockett, M. et al. (2017) A survey of acute pain services in the UK. Anaesthesia. Vol. 72 (Issue 10) pp. 1237–1242.

Time to take action on doctor fatigue

March 17th is World Sleep Day and the Royal College of Anaesthetists and  the Association of Anaesthetists of Great Britain and Ireland are calling for action on the issue of safe working hours for doctors.

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On World Sleep Day, which highlights the importance of getting adequate sleep, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) sets out its three-point plan to address the culture surrounding doctor fatigue in hospitals and tackle the problem of excessive fatigue. Such fatigue 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 drive home following a night shift.

A survey by the Royal College of Anaesthetists (RCoA) also shows that 85% of junior anaesthetists are at high risk of burnout; fatigue is known to be a risk factor for this.

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.

 

Patients ‘at risk’ as the anaesthetists shortage is predicted to increase

Campbell, D. The Observer. Published online: 11th June 2016

11415-2The NHS faces a critical shortage of anaesthetists that could force operations to be delayed and even threaten patient safety, doctors’ leaders have warned.

New research shows that by 2033 every hospital trust will have 10-20 fewer consultant anaesthetists than they will need to meet rising patient demand. It estimates that, while the NHS has agreed that its total of anaesthetists should expand to 11,800 by that date, on current trends it is likely to reach only 8,000 – a shortfall of 3,800, or about 33%.

The Royal College of Anaesthetists (RCoA), which carried out the research, warned that patients and the smooth running of hospitals would be hit if the existing shortfall in numbers was allowed to increase. Dr Liam Brennan, the college’s president, said: “Anaesthetists possess a unique and non-transferable skill set that is essential to maintaining core hospital services, so the potential impact of a reduced anaesthetic workforce would have serious implications for patient safety across the whole NHS. We already have fewer than we need and the shortages are worrying.”

The college’s latest census of the UK’s anaesthesia workforce, the first since 2010, also found that 74% of hospitals already rely on locum anaesthetists hired from medical employment agencies to ensure their rotas are full. The cost of that is part of the NHS’s huge annual bill – £3.7bn a year in England alone – for temporary staff.

Read the full news story here