Here Are Two Approaches for Managing Physician Fatigue

The strategies most institutions use to address fatigue are tried and true, says one researcher, but there is much room for advancement.

For physicians with relentless schedules, the risks associated with physician fatigue can be overwhelming. As physicians lose sleep and become more tired, they tend to slip up more—both on and off the job.

“Several studies show that fatigue affects physicians in multiple ways,” said Vineet Arora, MD, MAPPT, a physician researcher with University of Chicago Medicine, “for example, due to a higher risk of making medical errors and staff conflict.”

Fatigue has been associated with deteriorating cognitive function, impaired learning, memory deficits and more. One study found that more than half of 340 fatigued residents were involved in a car crash within a three-month period of being surveyed.

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“Typically, it’s younger physicians like residents working the ‘marathon shifts,’ ” Arora said. “However, it is not just them. Practicing physicians, particularly in subspecialties, can find themselves working very long hours if they are called in at night to deal with an emergent surgery.”

Fatigued physicians could potentially harm a patient with a lapse in judgment, or they could harm themselves while driving home after their shift. The potential for catastrophe has motivated some institutions to find more creative ways to to help keep health care professionals and their patients safe.

In a 2013 report published by Canada’s National Steering Committee on Resident Duty Hours , a team of experts compiled a set of recommendations for managing fatigue.

These include:

• Developing a fatigue risk management plan that can be used to educate physicians and residents.

• Using monitoring and enforcement mechanisms to manage fatigue on a routine basis.

• Teaching self-awareness and communication skills to health care professionals as a requirement for hospital accreditation.

• Using simulation experiences as teaching tools to facilitate more efficient learning.

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Though this report addresses resident duty hours specifically, the authors state the findings of the report are applicable to the health and well-being of other health care providers as well.

Far across the globe, another medical institution has created a tool to manage physician fatigue as well. The Australian Medical Association offers a web-based Fatigue Risk Assessment tool . The tool allows physicians to evaluate the safety of their daily schedules. It also provides an interface to track work, on-call, recreational and sleeping hours within a week.

The association asserts that tools like the Fatigue Risk Assessment help physicians maintain well-being, which is essential to providing quality care and experiencing a “rewarding and satisfying career.”

According to Arora, the tools most institutions use to manage fatigue are tried and true. The most common? Caffeine and naps. But she insists that there is much room for advancement, especially when it comes to incorporating technology into hospital systems.

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“I think the new developments may come in the form of technology to assess fitness for duty,” she said. “For example, cars are now equipped with automated technology to detect drowsy driving to reduce drowsy driving crashes. Similar technology could be applied to ensure physicians are alert.”

Arora believes the future of fatigue management would ideally take a more integrative approach that recognizes the importance of the overall well-being of health care professionals.

“There is still room for improvement, but it should be placed in context of promoting a culture of assessing and improving overall wellness and fitness for duty,” Arora said. “For example, addressing fatigue only does not really help if you are stressed or burned out and not able to access resources to improve your wellness.”