Doctors Shifts May Endanger Patients

Doctors who work shifts are more prone to health risks and sleep deprivation, which could have detrimental effects on patient safety, a BMA Scotland report said today.

The report, produced by the BMA's Scottish Junior Doctors Committee (SJDC), highlights the dangers of irregular shift patterns on health and performance and makes a series of recommendations to reduce these dangers.

Shift-work, Rest and Sleep: Minimising the Risks, calls on employers to develop safe rotas for staff and to encourage rest breaks during night shifts to ensure that patient safety is protected.

Many juniors work a combination of shifts, for example, a week of night shifts followed by another week of late shifts with a day or two off in between.

Whilst this pattern of shifts would be compliant with the European Working Time Directive (EWTD), the report argues that such long periods of unsociable hours can have serious implications for the health and wellbeing of doctors, and as a result, affect patient care.

The report said: "Due to a range of pressures, most recently the adoption of the EWTD into UK law, there has been a change from a traditional 24-hour resident-on-call pattern for junior doctors to a more regimented shift pattern, with the express aim of protecting employees from excessive work without adequate rest….However it has become evident that poor rota design of WTR-compliant shift patterns may also result in a shift structure predisposed to high-intensity work that may lead to fatigue and may carry unacceptable burdens of risk to doctors and patients."

The report stated that the key to good rota design is to avoid excessive out of hours working for individuals: "Many rotas which are compliant with New Deal and working time regulations (WTR) on paper may in fact lead to considerable predictable fatigue in the doctors who work those rotas.

"For example, there are juniors who are working rotas which include seven consecutive 12.5 hour nightshifts."

Dr Gordon Lehany, Chair of the SJDC said: "There is growing awareness of the dangers of sleep deprivation on performance as well as the health risks associated with irregular shift work.

"In the case of junior doctors, their working arrangements can be detrimental not just to their own health, but to patient care.

"It is important that as NHS boards try to become compliant with European Working Time Regulations they also consider safe shift working patterns. To do this effectively, junior doctors should be involved in drawing up rotas.

"It is essential that the problem associated with working irregular shift patterns are recognised and reduced," he said.

(BMcC/GK)