Fatigue in anaesthesiology: Call for a change of culture and regulations.
This editorial focuses on the difficulties of implementing Fatigue Risk Management Systems (FRMS) in healthcare – and more specifically in anaesthesia and intensive care. Written by members of the European Board of Anaesthesiology Standing Committee on Work Force, Working Conditions, Welfare, the article reiterates some of the knowledge we have gained about fatigue over the last 20 years suggests how this should influence the care of our patients but also ourselves as practitioners.
The article highlights that medicine is one of the last safety critical industries to not have an enforceable FRMS and looks at why this is. The reasons presented by the authors include: changing knowledge of how sleep is important; the difference in attitudes to work from baby boomers to generation X, Y and Z workers; and outdated attitudes such as “this is shift work, you don’t need a break”. The authors acknowledge that formal FRMS are not necessarily easily transferable to medicine especially in a workforce that is often understaffed.
The authors suggest simpler solutions – providing dark areas for staff to have power naps, teaching medical professionals about how to assess their own fatigue risk, ensuring senior clinicians/managers are aware of fatigue related risk and writing rosters appropriately to mitigate against these risks.
Finally, the article highlights the steps taken by several organisations to prevent fatigue related risk such as the FATIGUE project started in 2019 with the aim of “raising awareness about the consequences of fatigue on both patient safety and anaesthesiologist wellbeing” and the creation of the Fatigue and Facilities Charter by the British Medical Association. The authors suggest that we as high acuity clinicians should be more aware of the risks of fatigue to all involved, and that if 20% of people in our profession alter our behaviour to establish a new norm in which fatigue is acknowledged as a significant risk factor this will lead to a safer, more contented workforce.
Reviewed by Shona Chung