More than half of trainee hospital doctors have had an accident or near miss on their way home after a night shift due to sleep deprivation, according to new evidence about fatigue among NHS staff.
Doctors have described swerving across motorways, crashing into other vehicles, being stopped by police and hitting a kerb, verge or roundabout as a result of falling asleep at the wheel on their journey home.
In all, 1,229 (57%) of 2,155 trainee anaesthetists questioned had been involved in an accident, or come close to having one, while driving, motorcycling, cycling or walking home after working all night.
“I have fallen asleep at traffic lights. I once hallucinated on the motorway,” one doctor said. Another said: “Previously experienced microsleep/nodding off on the M5. Foot came off the gas pedal and the car slowly drifted into middle lane. Woke up when driver in van came up alongside me and honked continuously.”
Some suffered injuries ranging from minor bumps and scrapes to more serious harm, but others had written off their car and some incidents put others at risk, too. Almost all doctors admitted that the incidents were their fault, though caused by exhaustion.
Another respondent recounted how: “I’ve fallen asleep and drifted towards a lorry in the other lane of a dual carriageway. I’ve fallen asleep and hit a car coming the other way with our wing mirrors on a village road near home. I’ve also pulled out of a junction when someone was coming as I was so dopey after a night [shift].”
More than eight out of 10 (84%) of respondents said that they had felt too tired to drive home after a night shift. About 90% use caffeine-based drinks in order to stay awake on a night shift.
Seven out of 10 (72%) said that work-related fatigue had negatively affected their physical health, while almost as many said it had damaged their psychological wellbeing (69%) or personal relationships (66%). Over half (53%) of the trainee anaesthetists said fatigue had impaired their ability to do their job.
The findings, published in the medical journal Anaesthesia, have prompted calls for the NHS to do more to ensure that doctors on duty overnight can get some sleep during their shift or sleep in the hospital before heading home afterwards.
“These are very worrying findings. Junior doctors are putting their lives at risk due to fatigue resulting from their shift work and the lack of rest facilities at their hospitals both during and after shifts,” said Dr Laura McClelland, a co-author of the survey.
Extreme tiredness among doctors could also lead to them making mistakes when they are working at night, McClelland warned.
“It may lead people to believe that they are able to drive when they aren’t or to misjudge a clinical situation. We’re required to make judgements about everything from the clinical presentation of a patient to the drug doses we use and also the appropriate course of the clinical care. Fatigue can lead to anything going wrong in any of those processes,” she said.
A typical junior doctor’s night shift lasts for 12 and a half hours. But 17% of medics said they never managed a sleep of at least 30 minutes during that time.
“That 17% figure is a worry as it highlights that people on a night shift, who aren’t physiologically designed to be awake all night, aren’t having the opportunity to have the rest breaks required so that they can function optimally and safely, so they can give patients the best possible care and drive safely during their journey,” said Dr Jon Holland, another co-author.
At least three junior doctors have died in car crashes on their way home after nightshifts since 2013, added Holland. They include trainee anaesthetist Ronak Patel, 33. He died when he crashed his car into a lorry on his way home from the third of three successive night shifts at the Norfolk and Norwich hospital in Norwich. The inquest into his death heard that he had been singing to try to keep himself awake during the journey.
Many respondents said they had no opportunity to have a short sleep mid-shift because they were too busy or there were too few other doctors on duty to allow them to do that. A third (34%) did not have rest facilities available in their hospital to have a nap in mid-shift.
The Association of Anaesthetists of Great Britain and Ireland, which endorsed the study’s conclusions, believes that the loss of rooms in hospitals in which doctors could sleep during or after a night shift has led to increased fatigue among medics.
A Department of Health spokeswoman said: “We know how hard our junior doctors work to provide world-leading care and it is absolutely vital they get proper support. And that’s why their new contract has much stricter safeguards in mandating rest days after consecutive night shifts and reducing the maximum hours worked in any one week.”
