Anaesthetists in training working group on fatigue

The Association of Anaesthetists established a working group to help anaesthetics trainees with safe sleeping patterns. Here, Dr Emma Plunkett, consultant anaesthetist and chair of the working group, talks more about new initiatives to fight fatigue and why it’s important to monitor the impact of tiredness in the national training surveys.

Following the death of an anaesthetist in an accident driving home after a night shift, we investigated the impact of fatigue and shift work on trainee anaesthetists. An initial survey of Welsh trainees expanded across the UK with the help of the Association of Anaesthetists and Royal College of Anaesthetists (RCoA). with fatigue among our UK trainees.

To address the issues raised, we established a fatigue working group with the Association of Anaesthetists, RCoA, Faculty of Intensive Care Medicine and experts in the field. The group developed standards for rest facilities and culture. with factsheets about fatigue, sleep, how to manage shift working, and handover tools to promote consideration of the fatigue levels of staff. These are designed to be displayed in shared areas such as changing rooms or included in induction packs. Other resources include an induction slide set and video, as well as relaxation audio.

In March 2018, the working group invited organisations to back our #FightFatigue campaign. Anecdotally, we are aware that some organisations responded by finding rest facilities and adopting the handover tools. For others, change has been slower. Respondents to our initial trainee survey described feeling it wasn't appropriate to ask for a break during a night shift, and many described negative attitudes from management if they were 'caught sleeping'. We recognise that changing cultures like these will take time.

This year, all anaesthetics trainees were asked four new questions about fatigue and shift work as part of the speciality-specific questions in the national training survey. Three quarters of those who had received teaching on fatigue or sleep found it useful, but this opportunity was only available for about one third of trainees. One in three trainees felt too tired to get home safely monthly or more frequently. And over one third reported that work related fatigue had some impact or a significant impact on their progress through training. The inclusion of questions about fatigue in the national training survey is crucial, and we hope we can encourage continued improvement in all these areas.

Night workers should expect access to and the opportunity to use rest facilities. Some places do this well. We seek to encourage good practice and publicise successes to demonstrate that fatigue management has a positive effect on patient care and may also improve recruitment, retention, sickness rates and morale.

Dr Laura McClelland, anaesthetist in specialist training involved in the project said:

Undertaking work within this area has been both challenging and rewarding. Knowing that our endeavours will secure a safer future for both doctors and patients is what keeps us pushing forwards.

We are witnessing a very welcome and exciting change within the culture of the workforce. Fatigue is being openly discussed and collectively, doctors and employers are making steps to prevent and manage it. The landscape has already changed drastically and we are confident that the future will be better still.

As a member of the fatigue group, I've experienced first hand the challenges that have been navigated in order to produce real and sustainable change within this area. It is with great pride and gratitude to the efforts of so many that I am witnessing the evolution of a progressive fatigue culture improved safety for all.

Survey responses show the cultural change that has been achieved.

'I am absolutely certain that fatigue negatively affects my ability to revise for exams, my memory and recall and most of all my mood and general happiness.'

'It makes such a difference to close my eyes in a quiet room for 20-30 minutes (even if I am unable to sleep) either during the shift if workload allows, or in the morning before travelling home.'

'Knowing there is an on call room makes a huge difference to how I feel approaching night shifts (much less dread). Even if I only lie down for a brief period, I feel much more refreshed and able to work later in the shift.'

Dr Nancy Redfern, Vice President of the Association of Anaesthetists:

'The Association of Anaesthetists is working hard to raise awareness of the impacts of staff fatigue on the quality and safety of patient care and on our own wellbeing. Through our #fightfatigue campaign, we are providing practical resources to help to develop a culture in which the dangers of tiredness are recognised and managed. Our aim is to see good sleep hygiene during and after shifts become the norm and the provision of facilities for all NHS night shift workers to take power naps.'

The Royal College of Anaesthetists has said:

The Royal College of Anaesthetists remains committed to the safety, health and wellbeing of anaesthetists in training. We will continue to encourage, support and highlight examples of good practice in the field of fatigue support, education and safety. Looking to the future, we will continue to work with other organisations to tackle the long term issues of fatigue on the workforce.