Fighting Fatigue Together

Taking risks because of fatigue is not meant to be part of the job! 

Despite impressive advances in medical technologies, including monitoring, healthcare professionals still remain the central figures in ensuring patient safety. They are responsible for choosing, conducting, analysing and reacting to the results of various tests and monitoring processes. However, the reality of healthcare demands that these professionals work during hours when most others are asleep, forcing them to operate against their circadian rhythms and, in effect, combat their own biology. 

The first barrier to addressing this issue is recognising that working at night is fundamentally different from working during the day. It is crucial to acknowledge that healthcare workers are not immune to sleep deprivation’s short- and long-term consequences. Acute sleep deprivation, for instance, can increase susceptibility to respiratory infections. In contrast, chronic sleep deprivation is linked to a host of serious health issues, including sleep disorders, mental health problems, cardiovascular diseases, type 2 diabetes, and even an elevated risk of cancer. 

A particular risk to be mindful of is microsleeps—brief, involuntary episodes of sleep lasting a few seconds—that are highly implicated in car crashes, particularly in the early morning hours. The incidence of microsleeps increases drastically after the 25th hour of wakefulness, often when night shift workers drive home around 7 AM. After just 16 hours of wakefulness, individuals begin to experience impaired performance, including weakened working and executive memory, poorer communication, reduced detection of safety threats, and an increase in risk-taking behaviour. These effects are influenced by the level of stimulation as well as other internal and external factors. Given that healthcare professionals make critical decisions that directly impact patient outcomes, the risks associated with fatigue are highly relevant to patient safety. 

Given these risks, raising awareness about the importance of prophylactic napping and the need to take appropriate power naps during shifts is vital. A general understanding of these risks, along with built-in system checks and a culture of taking care of one another, can help mitigate these dangers. 

Secondly, employers must acknowledge how fatigue impacts healthcare workers and patient safety. They should introduce fatigue risk management plans and proactively seek areas for improvement. One straightforward strategy is to provide sleeping facilities for naps during appropriate times on night shifts and after shifts for those too tired to drive home safely. Other potential solutions include ensuring employees’ access to public transportation passes or subsidised taxi services, among various strategies. A culture that is free from blame is essential, allowing individuals to declare when they are too tired to perform a task safely. There should also be built-in double-checks that account for the limitations of the human circadian rhythm, including the natural dip in attention and focus that occurs around 4 AM. 

Thirdly, it is crucial for us, individuals working in anaesthesia and intensive medicine, to take responsibility for our own well-being and motivate our colleagues to do the same. We must actively use the facilities and measures provided by hospitals, as these are only effective if they are used. 

The tragic death of an anaesthesia resident in the UK in 2015 led to the launch of the “Fighting Fatigue” campaign in 2018. According to a survey conducted as part of this campaign, 57% of trainees had experienced an accident or near-miss while commuting to work. Recognising that fatigue is a significant risk—but should not be an accepted part of the job for anaesthesiologists—requires a cultural shift. Advocating for minimal standards of rest facilities may seem like common sense, but it has proven to be a challenge. 

In 2021, the European Patient Safety Foundation supported the “Fighting Fatigue Together” campaign. With the assistance of the UK team, the Foundation initiated a collaborative campaign to accelerate change by sharing the experiences and tools developed in the UK across Europe. The European Health Leadership Award in 2023 recognised this effort by the renowned European Health Forum Gastein (EHFG). Four countries—Croatia, Georgia, Spain, and Austria—were among the early adopters of this campaign. 

In Croatia, we also face a deeply ingrained culture where doctors often expect themselves and others to act like superheroes, frequently boasting about how exhausted they are. This mentality, while pervasive, only exacerbates the already high rates of burnout among healthcare professionals. The recent opening of the Schengen work market and the proliferation of private clinics have further intensified these pressures, jeopardising public healthcare access and posing serious risks to patient safety and healthcare workers’ well-being.  

So far, the “Fighting Fatigue Together” campaign in Croatia has relied on raising awareness through the power of social media, including a dedicated Facebook page, giving talks at relevant society conferences, national newspapers, and advocating for appropriate rest facilities. Of particular note is the participation of nationally recognised influencers from the medical profession in social media and collaboration with young doctors’ movements aimed at improving mental health. Their involvement has significantly helped spread awareness of the campaign, proving to be an invaluable resource. The role of these influencers in public health campaigns is perhaps underappreciated, but their ability to engage and educate both peers and the public cannot be overstated. The preliminary success of the FFT campaign is largely due to the collaboration of the national anaesthesia and Intensive Medicine Society, HDARIM, the Nurses’ association (Croatian Association of Nurses in Anesthesia, Resuscitation, Intensive Care, and Transfusion), and the young doctors’ association. Young doctors are beginning to openly share their stories of burnout and fatigue, courageously demanding the support and systemic changes necessary to safeguard their health and their ability to provide quality care. We strongly encourage everyone in the healthcare community to join the fight against fatigue and work together to foster a safer, more sustainable future for all. 

Author

•  Dora Karmelic

Figure 1: One of the posters from the Fighting Fatigue Together campaign 

Figure 2: One of the more popular social-media posts with a testimonial by Natko Beck MD, a radiologist and public health influencer, about his experience with fatigue-related car crash, realised in collaboration with Sentinel uma, a young doctors’ movement advocating mental health 

Figure 3: Implementation workshop of Fighting Fatigue Together campaign international outreach – first adopters outside the UK.