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Peri-operative night-time work of anaesthesiologists: A qualitative study of critical issues and proposals
Mariachiara Ippolito1, Alberto Noto, Ines Lakbar
1From the Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo (MI, AG, AC), Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo (MI, AG, AC), Division of Anaesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age 'Gaetano Barresi', University of Messina, Policlinico 'G. Martino', Messina, Italy (AN), Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier Cedex 5, Montpellier, France (IL), Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA (AC), Outcomes Research Consortium, Cleveland, OH, USA (AC), Department of Paediatric and Obstetric Anaesthesia, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (AA), Institute of Clinical Medicine, University of Copenhagen (AA), Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany (PK), Consorcio Hospital General Universitario de Valencia, Valencia. Methodology research Department, Universidad Europea de Valencia, Spain (CSRG), Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India (SNM), Department of Intensive Care, Amsterdam University Medical Centers, Location 'AMC', Amsterdam, The Netherlands (MJS), Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand (MJS), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, UK (MJS), Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I Teaching Hospital, Sapienza University of Rome, Rome (FB), Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and surgery. University of Perugia, Italy (EDR) and General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel (SE).
Background:
Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking.
Objectives:
This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks.
Design:
Qualitative analysis of responses to two open-ended questions.
Setting:
Online platform questionnaire promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC).
Participants:
The survey sample consisted of an international cohort of anaesthesiologists.
Main Outcome Measures:
We identified and classified recurrent themes in the responses to questions addressing perceptions regarding (Q1) peri-operative night-time working conditions, which may affect patient safety and (Q2) potential solutions.
Results:
We analysed 2112 and 2113 responses to Q1 and Q2, respectively. The most frequently reported themes in relation to Q1 were a perceived reduction in professional performance accompanied by concerns regarding the possible consequences of work with fatigue (27%), and poor working conditions at night-time (35%). The most frequently proposed solutions in response to Q2 were a reduction of working hours and avoidance of 24-h shifts (21%), an increase in human resources (14%) and performance of only urgent or emergency surgeries at night (14%).
Conclusion:
Overall, the surveyed anaesthesiologists believe that workload-to-staff imbalance and excessive working hours were potential bases for increased peri-operative risk for their patients, partly because of fatigue-related medical errors during night-time work. The performance of nonemergency elective surgical cases at night and lack of facilities were among the reported issues and potential targets for improvement measures. Further studies should investigate whether countermeasures can improve patient safety as well as the quality of life of anaesthesia professionals. Regulations to improve homogeneity, safety, and quality of anaesthesia practice at night seem to be urgently needed.
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