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Audit reveals public hospital shifts still dangerous

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 There are still too many doctors working unsafe shifts in Australian public hospitals, according to an audit of hospital working conditions for doctors.

The AMA’s fourth nationwide survey of doctors’ working hours shows that one in two Australian public hospital doctors (53 per cent) are at significant or high risk of fatigue.

A report of the 2016 AMA Safe Hours Audit was launched on July 15 and showed that while an improvement has been recorded since the first AMA Audit in 2001 (when 78 per cent of those surveyed reported working high risk hours), the result has not changed since the last AMA Safe Hours Audit in 2011.

The report confirms that although there has been an overall decline in at-risk work hours in the past decades, the demands on many doctors continue to be extreme.

“The AMA audit has revealed work practices that contribute to doctor fatigue and stress remain prevalent in Australian public hospitals and can impact on the ability of doctors to work effectively and safely,” said AMA Vice President Dr Tony Bartone.

“It’s no surprise that doctors at higher risk of fatigue reported to work longer hours, longer shifts, have more days on call, less days off and are more likely to skip meal breaks.”

One doctor reported working a 76-hour shift in 2016, almost double the longest shift reported in 2011, and the maximum total hours worked during the survey week was 118 hours, which was no change since 2006.

The most stressed disciplines were Intensive Care Physicians and Surgeons with 75 and 73 per cent respectively reporting they were working hours that placed them at significant or high risk of fatigue.

Research shows that fatigue endangers patient safety and can have a real impact on the health and wellbeing of doctors. This audit shows that the demands on public hospital doctors are still too great and State and Territory governments and hospital administrators need to intensify efforts to ensure better rostering and safer work practices for hospital doctors.

However, the AMA says that reducing fatigue related risks does not necessarily mean doctors have to work fewer hours, just better structured ones.

“It could be a case of smarter rostering practices and improved staffing levels so doctors get a chance to recover after extended periods of work,” Dr Bartone said.

“Safe rostering practices are a critical part of ensuring a safe work environment. Rostering and working hours should contribute to good fatigue-management and a safe work and training environment.

“This includes implementing and supporting rostering schedules and staffing levels that reduce the risk of fatigue, providing appropriate access to rest and leave provisions. And for clinicians, protected teaching and training time, and teaching that’s organised within working hours.

“Employers have an obligation and a duty to provide a safe workplace. They can support staff to maintain a healthy lifestyle and work-life balance by making provisions available for leave and by providing flexible work and training arrangements.

“Research shows that this not only benefits the health and wellbeing of doctors but contributes to higher quality care, patient safety, and health outcomes.

“The Austin and Monash hospitals in Victoria are currently trialling a rostering schedule to mitigate against fatigue based on sleep research. This is the kind of innovative rostering that we’d like to see more of.”

Fatigue has a big effect on doctors in training, who have to manage the competing demands of work, study and exams.

The report showed that six out of ten Registrars are working rosters that place them at significant or higher risk of fatigue compared to the average of five out of ten hospital based doctors.

“Public hospitals need to strike a better balance to provide a quality training environment that recognises the benefits that a safe working environment and teaching and training can bring to quality patient care,” said Dr John Zorbas, Chair of the AMA Council of Doctors in Training.

“The audit suggests that six out of ten Registrars are working shifts and rosters that put them at risk of fatigue. The number of Interns and RMOs working at high risk of fatigue has also increased by 11 per cent compared with the 2011 report.

“Public hospitals in conjunction with medical colleges need to urgently review training and service requirements and implement rostering arrangements and work conditions that create safe work environments and provide for high quality patient care.

“This could include improving access to suitable rest facilities or making sure doctors have access to sufficient breaks when working long shifts.

“The AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors provides advice on best practice rostering and work arrangements. We’d encourage every hospital to look at this and adopt it as best practice to provide safe, high quality patient care and a safe working environment for all doctors.”

While the profile of doctors working longer hours has decreased across medical disciplines since the AMA’s first survey in 2001, many procedural specialists are still working long hours with fewer breaks.

Three out of four Intensivists (75 per cent) and Surgeons (73 per cent) reported to work rosters that place them at significant and higher risk of fatigue, significantly more than the 53 per cent reported by all doctors.

Further, there is evidence that extreme rostering practices remain with shifts of up to 76 hours and working weeks of 118 hours reported amongst doctors at higher risk of fatigue.

The 2016 Audit confirms that doctors at higher risk of fatigue typically work longer hours, longer shifts, have more days on call, fewer days off and are more likely to skip a meal break.

These are red flags that public hospitals need to urgently address in their rostering arrangements.

The 2016 AMA Safe Hours Audit Report is at: article/2016-ama-safe-hours-audit

The AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors is at: article/national-code-practice-hours-work-shiftwork-and-rostering-hospital-doctors