Working Hour Cuts Won't Solve Junior Doctors' Fatigue And Related Error Risk

Main Category: Sleep / Sleep Disorders / Insomnia
Article Date: 25 Mar 2007 - 0:00 PDT


Cutting junior doctors' working hours and giving them more rest breaks won't by itself reduce fatigue or the attendant risk of error, concludes a study published ahead of print in Occupational and Environmental Medicine .

An anonymous questionnaire on work patterns, sleepiness and errors related to tiredness was sent to more than 2000 junior doctors.

The doctors were working 40 or more hours a week in accordance with schedules designed to cut weekly working hours, ensure adequate rest breaks, and reduce the associated risk of errors.

Almost 1400 responses were received and each participant was given a fatigue risk score by combining 10 aspects of work patterns and sleep in the preceding week.

Almost a third (30%) of respondents were classified as "excessively sleepy" according to a recognised sleepiness scale.

One in four said that since becoming a doctor they had fallen asleep at the wheel of their car while driving home.

Two thirds said they had come close to falling asleep at the wheel in the previous 12 months, and one in five said that this had happened on at least five occasions.

The doctors were twice as likely as the general population to score as excessively sleepy, and more than twice as likely to report nearly falling asleep at the wheel as British male drivers.

Two thirds said that they had made a mistake associated with fatigue at some point in their careers, while more than four out of 10 said that this had happened in the preceding six months.

The higher their fatigue risk score, the higher were the chances that they had nearly fallen asleep while driving and that they had made a mistake in the preceding six months.

Night shifts and unscheduled changes to rosters were more consistently linked to sleepiness and errors than the total number of hours worked, after taking account of age and other factors.

Conversely, regular access to supervision reduced the likelihood of sleepiness and errors, irrespective of the total hours worked.

"We conclude that long work hours are not the only aspect of work patterns that needs to be managed to reduce sleepiness and fatigue related clinical errors among junior doctors," say the authors.

"The findings support the view that a more comprehensive risk management approach is needed to reduce doctors' sleepiness and improve patient safety," they add.

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