A prospective analysis of shift work and fatigue scores in anaesthesiology registrars at four Johannesburg hospitals

Abstract

Background: Fatigue among anaesthesiologists is a critical safety concern. The prevalence of fatigue is high among South African doctors, with an unknown prevalence among South African anaesthesiologists. This study aimed to determine the fatigue scores of anaesthesiology registrars at four academic hospitals in Johannesburg.

Methods: This was a prospective, cross-sectional study using selective sampling. Data were collected from shifts worked by 47 anaesthesiology registrars in the Department of Anaesthesiology at the University of the Witwatersrand across the four academic hospitals. Objective and subjective fatigue scores for each completed shift worked by each anaesthesiology registrar were obtained using the Fatigue Audit InterDyne (FAID^®) Quantum tool by InterDynamics (Brisbane, Australia) and the Karolinska Sleepiness Scale (KSS), respectively. Descriptive statistics, t-tests, ANOVA, chi-square tests, and correlation and agreement analyses (Pearson, Spearman, and Kappa tests) were used to analyse the data.

Results: A total of 1 321 shifts were analysed across 47 anaesthesiology registrars. There were 183 shifts (13.9%, 95% confidence interval [CI] 12.0 to 15.8) that scored a dangerous level of objective fatigue during a shift. Also, 446 shifts (33.8%, 95% CI 31.2 to 36.4) scored a dangerous level of subjective fatigue after a shift, indicating an elevated risk of fatigue-related errors (p < 0.001). A moderate positive correlation of 0.35 was observed between the two fatigue scores (p < 0.001).

Conclusion: Anaesthesiology registrars at the University of the Witwatersrand experience fatigue that can be considered dangerous based on objective and subjective scores. The implications of fatigue on clinical decision-making and burnout present important areas for future research.