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Education should be provided for all members of the department about fatigue, including sleep hygiene and the legal implications of driving while tired.⁴⁸

Standardised scoring systems such as fatigue tools identifying team members’ level of fatigue should be used at handover and there should be no criticism of the need to rest.⁴⁹

Facilities should be provided for regular rest breaks and refreshments as well as quiet facilities for sleep during and after shifts for anaesthetists working overnight.^34,43,50,51

If anaesthetists finishing a night shift have had no rest, the reasons for this should be explored and they should be offered and encouraged to use hospital rest facilities.^52,53

Departments should have processes in place that promote a sensible work-life balance and should identify and reduce stress and burnout.⁵³

Stress, 'burnout' and mental ill health are major causes of sickness absence. NHS organisations should ensure that those in leadership positions work to promote and protect the health and wellbeing of staff.⁵⁴

Departments should be aware that colleagues may still attend work even when they do not have the physical or psychological resources to do the job well. Processes should be in place to address these situations sensitively.⁵⁴

Departments should be aware of the factors that increase the risk of stress, burnout and depression and the impact this may have on sick leave. Departments should make use of tools such as burnout questionnaires to identify departmental wellbeing and focus support.⁵⁵ Departments should consider how to support colleagues in opportunities to exercise and provide adequate time to allow...

Departments should be aware of the increased risk of suicide in healthcare workers, the increased vulnerability due to access to drugs and potential trigger factors including adverse events, litigation and investigation, conflict with colleagues and significant life events.^56,57

There should be clear guidance on the behaviours expected of all colleagues and a mechanism for colleagues to raise concerns about poor behaviour of colleagues.¹²