Sleep deprivation putting patients ‘at risk’

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DANGEROUS working patterns that see consultants treating patients without having time off to rest after being on call risk patient safety, leading doctors have warned.

Survey results published today by the British Medical Association (BMA) ahead of its annual meeting found that 71 per cent of consultants never have access to rest time following a night spent on call when their sleep had been disturbed, and a further one in ten said that such rest was rare.

Almost nine in 10 consultants reported being on an on-call rota, with just under half being called to attend hospital during the week, rising two thirds at weekends.

With the average call out time at three hours during the week and doubling to six hours at weekends, not having proper rest time compromises patient safety and puts consultants at risk of fatigue and burnout, the BMA said.

One consultant cardiologist, working in the north west, said “intense working patterns” left him finding it difficult to concentrate at work, and reported being called into the hospital three nights in a row, on top of working throughout the day.

He said he’d witnessed colleagues “suffering from burnout” or choosing to leave medicine altogether.

The BMA surveyed 847 consultants across England and Northern Ireland and found the vast majority were on an on call rota, 88 per cent. Almost half reported being called to attend the hospital through the week, with a higher rate of call outs when they were on call during the weekend.

Almost half said their sleep was disturbed during week night on call shifts.

The BMA pointed to research that showed the number of hours awake can be similar to blood alcohol levels, with 21 hours awake being the equivalent blood alcohol content of 80mg in 100ml, the legal drink driving limit, and 24 hours awake taking you over the limit to 100mg.

Dr Paul Flynn, chair of the BMA’s consultants committee, said: “Our concerns about consultants’ fatigue and burnout are well-founded. Sleep deprivation can impair judgement and decision making, skills that are vital for doctors. Studies have shown it can have similar effects to drinking.

“We would never allow a consultant under the influence of alcohol to treat patients, but continue to turn a blind eye to doctors who are sleep deprived.

“This has the potential to lead to the same problems that consultants experienced as junior doctors – no one wants to see a return to the dark days of doctors working dangerously long hours.”

The BMA is calling for greater protections in the contracts of consultants.

This has been echoed by North Yorkshire consultant Dr Ian Wilson, who also chairs the BMA Representative Body.

He warned: “The consultant contract must continue to have robust protections against the acute fatigue that poses risks to patients and the chronic fatigue that risks burnout for consultants.

“With workloads rising and moves to deliver more services out of hours, the Government must make safe working a priority.”

NHS employers must comply with Working Time Regulations, which set out the minimum requirement for rest periods.

A Department of Health spokesperson said: “Local NHS organisations have a legal duty to make ensure that all staff including doctors take adequate rest periods so that they are not tired, and safety is not impaired.“

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