Fatigue and its role in night surgery adverse events
Responding to the publication of a paper in the British Journal of Anaesthesia that reports a higher incidence of adverse patient safety events during night-time surgery, Dr William Harrop-Griffiths, Chair of the Royal College of Anaesthetists’ Clinical Quality and Research Board said:
“The findings of this study will be a concern for all clinicians. It may well be that the increased incidence noted in this study is in large part the result of clinician fatigue and other human factors.
Fatigue amongst healthcare workers is an important issue that the College has been working to address in partnership1 with the Faculty of Intensive Care Medicine and the Association of Anaesthetists. From encouraging and educating anaesthetists on how to rest during and after night shifts, to working with hospitals in protecting or re-instating rest and catering facilities, and helping anaesthetists know how to work within their limits, we are pleased that important issue of fatigue is now being discussed at hospital, Trust and Government level.
Another aspect we are addressing is the ageing anaesthetist2. As changes to pensions and working patterns cause the NHS workforce to age, this will affect doctors’ abilities to work in acute settings such as anaesthesia when they are in their mid-sixties or even older.
Over time, the mental flexibility, skills and reaction times of all doctors, including surgeons and anaesthetists, diminish. Anaesthesia is a safety-critical specialty in which a ‘routine case’ can change quickly into a life-threatening emergency, and rapid, accurate action is required to manage the situation safely. Research evidence shows that vigilance and some aspects of cognitive function become more variable with age, the capacity to adapt to night work is reduced, and tiredness can further worsen older doctors’ performance.
Addressing fatigue amongst doctors of all grades and in all specialties is an important issue that the NHS and independent hospitals need to tackle. With the anaesthetic specialty currently leading the way on this topic, resources and information packs3 developed can be used by doctors and hospitals across the UK to ensure we are all providing patients with the best possible care day or night.”
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