Emergency medicine Well-being week: Rotas, Shift-work and fatigue.
Emergency medicine is, and always will be, a 24/7 specialty. Those of us working in EM need to develop systems that offer safe, high quality care around the clock in ways that are sustainable for staff. We need to make it work.
My suggestion: engage with your ED and your Guardian of safe working. Help make it better for those who come after you. And look after yourself too. Rota design and administration, I’m reliably informed, is a demanding and thankless task. The best rotas (subjectively) include forward cycling (shifts getting progressively later); frequent rest days and a balance of 'in hours' (better for training and assessments) and out of hours (to experience greater autonomy and responsibility).
There is widespread evidence that fatigue impairs cognition, situational awareness and fine motor skills and is linked to errors. It is harmful to staff (both in terms of long-term health and accidents, e.g. driving home). Fatigue among staff also impacts on patient safety. Although caffeine and attention to hydration and diet help, adequate rest is the only cure.
As with much in Emergency medicine, it is necessary sometimes to be the best with what we have. There are some excellent tips for before and after night shifts, again from St. Emlyn’s (@stemlyns) http://stemlynsblog.org/not-night-shift Do what works for you. I had planned routines around night shifts before I had children. Now I get whatever sleep I can, when I can. I do, however, recommend portable blackout blinds and judicious caffeine.
Final point: to give safe, quality care at all times of day and night sustainably we have to also look after ourselves and our teams.