McClelland, L. et al. | A national survey of the effects of fatigue on trainees in anaesthesia in the UK | Anaesthesia |2017; 72: 1069–77
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.
These authors conducted a national survey to assess the incidence and effects of fatigue among the 3772 anaesthetists in training within the UK.
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.
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
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.
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:
- 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.
Service pressures and the role of anaesthetists in training – joint RCoA & AAGBI statement
The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists of Great Britain & Ireland (AAGBI) have issued the following statement in light of some anaesthetists in training being asked to work outside of their usual scope of practice due to recent unprecedented demands on clinical services:
Patient safety should be the first priority of all NHS staff at all times. To support the needs of patients, and their safety, we believe the following principles are important when redeployment of trainees in our specialty is being considered although some of the points made would be equally applicable to non-trainee colleagues:
- Trainee anaesthetists should be redeployed from their normal duties only in exceptional circumstances, and for the shortest possible length of time. The decision to do so should be made only by the Medical Director or deputy taking account of all service pressures and the clinical environment pertaining at that time.
- Trainee anaesthetists should never practice beyond their competence. Trainees working in unfamiliar environments must have clear lines of supervision and responsibility established, and they must always receive adequate induction and be familiar with local governance arrangements.
- It is important that those trainees asked to help support a part of the service under pressure are selected equitably from all of the medical staff competent to contribute to that aspect of the hospital’s clinical activity and that the number of sessions each redeployed trainee spends in another clinical service is closely monitored.
- If as a result of a change in duties an anaesthetic trainee misses an important training opportunity, it should be clearly outlined how this training will be accessed in a timely manner once the crisis has passed. We would encourage trainees to reflect on their experiences of working under these circumstances with their educational supervisors so that trainers can fully understand the problems trainees face and the potential for learning in these unfamiliar environments.
The decision to alter a trainee anaesthetist’s duties should be communicated by the Medical Director to the local Guardian of safe working, the trainee’s educational supervisor, RCoA Tutor (who should inform the relevant RCoA Regional Advisor) and Postgraduate Dean at the earliest opportunity. This should outline the circumstances that led to the redeployment being necessary; how long it will last for and the actions that will be put in place to avoid a recurrence in the future”.
van der Wal, R. et al. European Journal of Anaesthesiology: March 2016 – Volume 33 – Issue 3 – p 179–186
Background: The practice of anaesthesia comes with stress. If the demands of a stressful job exceed the resources of an individual, that person may develop burnout. Burnout poses a threat to the mental and physical health of the anaesthesiologist and therefore also to patient safety.
Objectives: Individual differences in stress appraisal (perceived demands) are an important factor in the risk of developing burnout. To explore this possible relationship, we assessed the prevalence of psychological distress and burnout in the Dutch anaesthesiologist population and investigated the influence of personality traits.
Results: Respectively, psychological distress and burnout were prevalent in 39.4 and 18% of all respondents. The prevalence of burnout was significantly different in resident and consultant anaesthesiologists: 11.3% vs. 19.8% (χ2 5.4; P < 0.02). The most important personality trait influencing psychological distress and burnout was neuroticism: adjusted odds ratio 6.22 (95% confidence interval 4.35 to 8.90) and 6.40 (95% confidence interval 3.98 to 10.3), respectively.
Conclusion: The results of this study show that psychological distress and burnout have a high prevalence in residents and consultant anaesthesiologists and that both are strongly related to personality traits, especially the trait of neuroticism. This suggests that strategies to address the problem of burnout would do well to focus on competence in coping skills and staying resilient. Personality traits could be taken into consideration during the selection of residents. In future longitudinal studies the question of how personal and situational factors interact in the development of burnout should be addressed.
Read the article abstract here
Prottengeier, J. European Journal of Anaesthesiology: March 2016 – Volume 33 – Issue 3 – p 195–203
Background: Dual-tasking, the need to divide attention between concurrent tasks, causes a severe increase in workload in emergency situations and yet there is no standardised training simulation scenario for this key difficulty.
Objectives: We introduced and validated a quantifiable source of divided attention and investigated its effects on performance and workload in airway management.
Participant: One hundred and fifty volunteer medical students, paramedics and anaesthesiologists of all levels of training.
Interventions: Participants secured the airway of a manikin using a supraglottic airway, conventional endotracheal intubation and video-assisted endotracheal intubation with and without the Paced Auditory Serial Addition Test (PASAT), which served as a quantifiable source of divided attention.
Results: All 150 participants completed the tests. Volunteers perceived our test to be challenging (99%) and the experience of stress and distraction true to an emergency situation (80%), but still fair (98%) and entertaining (95%). The negative effects of divided attention were reproducible in participants of all levels of expertise. Time consumption and perceived workload increased and almost half the participants make procedural mistakes under divided attention. The supraglottic airway technique was least affected by divided attention.
Conclusion: The scenario was effective for simulation training involving divided attention in acute care medicine. The significant effects on performance and perceived workload demonstrate the validity of the model, which was also characterised by high acceptability, technical simplicity and a novel degree of standardisation.
View the abstract here
Anaesthesia UK: 2nd February 2016
The latest census of consultant physicians and higher specialty trainees in the UK (2014/15) produced by the Royal College of Physicians, Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow, highlights significant concerns around filling gaps in trainee rotas.
Published in full today, the annual census measures the number of UK consultants and higher specialty trainees in all medical specialties, as well as capturing the views of those in the profession.
As part of the census, consultant physicians were asked about the gaps they face in their trainees’ rotas and their concerns. The findings from the consultant census show that trainee rota gaps were reported by 21% of respondents as, ‘frequent, such that they cause significant problems for patient safety’. This problem is reported more among consultants who have an acute or general medical commitment (28%). A further 48% stated rota gaps happened ‘often, but usually with a workaround solution such that patient safety is not compromised’.
The consultant census also notes, along with previous years, the growing need for consultants who can meet the needs of frail older patients. Following trends noted in last year’s census, the greatest increase in consultant jobs advertised have been in acute medicine and geriatric medicine, suggesting a move away from specialist working to more generalist roles treating acutely ill patients.
The nature of patients coming to hospital is changing. Sixty-five per cent of people admitted to hospital are over 65 years old and many have multiple complex conditions – often such patients require increased generalist input, as highlighted by the RCP’s Future Hospital Commission report.