AAGBI statement in response to doctor fatigue report on the BBC's The One Show and Inside Out South
In response to tonight’s reports on the BBC’s The One Show and Inside Out South about doctors driving home after nightshifts, the Association of Anaesthetists of Great Britain and Ireland (AAGBI) and its committee representing trainee anaesthetist doctors - the Group of Anaesthetists in Training (GAT) - are encouraged to hear about the work done by Dr Farquhar (Sleep Medicine Consultant) and his colleagues at Evelina London Children’s Hospital to educate doctors working in paediatrics about the important issue of fatigue.
We are concerned about the dangers of doctors driving home after a night shift and welcome this issue being highlighted in the media. We call for NHS employers to ensure that there is easy access to appropriate rest facilities to allow staff to take short naps, where clinically appropriate, during a night shift and also to ensure that anyone needing to rest before driving home is able to do so.
Anaesthetists are a vital part of the 24/7 urgent and emergency hospital care for patients in the operating theatres, intensive care units, delivery suites, emergency departments and wards; making critical decisions about patients and performing complex procedures. Along with other emergency care providers, anaesthetists regularly work night shifts. For safe working, it is crucial that these staff are aware of the risks of fatigue and are able to mitigate these risks by taking short rest breaks and sleeping before driving home.
In 2004 the AAGBI published the Fatigue and Anaesthetists guideline, reviewed and updated in 2013i. This guideline defines fatigue, its causes and risks and suggests strategies to reduce these. In 2006, the Royal College of Physicians of London published guidance for junior doctors working night shiftsii and last year, there were several articles published in leading journals discussing the risks of shift work iii/iv. Despite the availability of this guidance, there is still a need to improve the culture around fatigue in healthcare workers. The AAGBI and GAT have set up a working party to establish ways to work with doctors and departments/hospitals to address this.
The working party has supported and promoted a national survey of anaesthetic junior doctors on this subject. The results from a pilot survey were striking; 60% of respondents said they had either had an accident or near miss when driving home after a night shift and only 36% reported the existence of post on call rest facilities in their hospital. The full survey closed at the end of 2016 with over 2200 responses, and the results will be available later this year. The results reported by Doctors.net.uk suggest similar problems facing the doctors completing their survey.
However, defining the problem is only the beginning. We need solutions. The AAGBI and GAT, in conjunction with the Royal College of Anaesthetists, are working on an education package for anaesthetic departments to ensure that doctors are aware of the risks of fatigue and how they can reduce these. We want to work with departments and hospitals to work out ways to provide the change in culture and the rest facilities that are urgently needed.
- Ends -
i. Association of Anaesthetists of Great Britain and Ireland. Fatigue and Anaesthetists. October 2014
ii. Royal College of Physicians on London. Working the nightshift: preparation, survival and recovery. A guide for junior doctors. 2006 ISBN 1 86016 259 2
iii. M Farquhar. Fifteen-minute consultation on problems in the healthy paediatrician: managing the effects of shift work on your health. Arch Dis Child Educ Pract Ed doi:10.1136/archdischild-2016-312119
iv. G Kecklund & J Axelsson. Health consequences of shift work. BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5210