The burden of peri-operative work at night as perceived by anaesthesiologists: An international survey

Association of impostor phenomenon and burnout among Swiss residents and junior anaesthesiologists: results of a cross-sectional survey

BACKGROUND

Imposter phenomenon (IP) can impact professional performance and has been described as a risk factor for burnout within healthcare workers. We hypothesize that IP and burnout are prevalent among Swiss anaesthesiology residents and junior anaesthesiologists, and that specific risk factors are significantly associated with these conditions.

METHODS

We conducted a cross-sectional web-based survey of anaesthesiologists working in regions of Switzerland. The survey included demographic questions, the Clance Impostor Phenomenon Scale (CIPS), and the Maslach Burnout Inventory for Medical Personnel (MBI-HSS-MP). Descriptive statistics and logistic regression were used to identify demographic variables predictive of IP and burnout and to examine the association between IP and burnout.

RESULTS

A total of 318 people were eligible to participate. Of those, 136 (42.8%) participants completed the CIPS, and 127 (39.9%) completed the MBI-HSS-MP. Among CIPS respondents, 55% (75/136) identified as women, and 59% (80/136) were Swiss nationals. The prevalence of IP was 56% (76/136) and burnout was 10.2% (13/127). Women were more at risk of IP and burnout (p = 0.037). Independent covariates associated with IP were woman gender (p = 0.015) and Swiss nationality (p = 0.023). Additionally, the presence of IP was correlated with an increased likelihood of burnout (p = 0.04).

CONCLUSIONS

IP was correlated with the presence of burnout in anaesthesiologists in training. Additionally, IP affected more than half of the participants. Two risk factors were identified for IP: being a woman and a Swiss national. The rates of IP and its concerning association with burnout among resident and junior anaesthesiologists needs to be addressed.

TRIAL REGISTRATION

NCT06097325, https://www.

CLINICALTRIALS

gov/study/NCT06097325.

Airway management in pediatrics: improving safety

Airway management in children poses unique challenges due to the different anatomy, physiology, and pathophysiology across the pediatric age span. The recently published joint European Society of Anaesthesiology and Intensive Care-British Journal of Anaesthesia (ESAIC-BJA) neonatal and infant airway management guidelines provide recommendations and suggestions to support clinicians in deciding the best strategy. These guidelines represent a framework with the most recent and up-to-date evidence, from the initial assessment to the management of normal and difficult airways up to the extubation phase. However, such guidelines have intrinsic limitations due to the lack of supporting evidence in various fields of airway management. Pediatric institutions should adopt guidelines after careful internal review according to the local circumstances, including caseload, equipment and expertise. The current narrative review focused on providing references and practical tips on pediatric airway management, which is still not completely elucidated. Moreover, the authors put particular emphasis on the influence of human factors on the overall success of tracheal intubation, the incidence of complications, and the outcomes for patients.

Challenges in professional development of anaesthesiology trainees: A cross-sectional survey by the European Society of Anaesthesiology and Intensive Care Trainee Committee

BACKGROUND

The coronavirus disease (COVID-19) pandemic disrupted training in anaesthesiology. The global shortage of healthcare workers has also negatively affected training opportunities.

OBJECTIVE

To evaluate the current experiences, challenges and professional development of anaesthesiology trainees across Europe.

DESIGN

An online cross-sectional survey of anaesthesiology trainees.

PARTICIPANTS

Anaesthesiology trainees from the 42 European Society of Anaesthesiology and Intensive Care (ESAIC)-affiliated countries.

MAIN OUTCOME MEASURES

Quality of training supervision and program structure; the impact of COVID-19 on training and practical learning, trainee support systems, financial challenges and professional development, involvement in the ESAIC Exchange Program and career mobility insights.

RESULTS

Seven hundred and seventy-one participants from 35 ESAIC-affiliated European countries highlighted several aspects of anaesthesiology training. Approximately 30.5% of trainees reported being able to independently anaesthetise patients with ASA class 1 and 2 within 3 months, whereas independence for ASA 3 and 4 patients under indirect supervision was achieved by 24.3% between 6 and 9 months. Half of the respondents attained an independent working capacity in the ICU after 1.5 years. Although 51.3% reported receiving adequate training and supervision, only 30.1% received employer financial support for educational activities. The COVID-19 pandemic led to 40.2% being redeployed, primarily to ICUs, with 45.2% experiencing negative training effects. Career-wise, 12.5% engaged in international exchange programs, and 49.1% considered relocating for better career opportunities and work-life balance.

CONCLUSION

The findings provide valuable insights into the current state of anaesthesiology training in Europe, highlighting the need for adaptive strategies in medical education and training to meet evolving challenges and ensure continual professional growth.

Effects of fatigue on anaesthetist well-being and patient safety: a narrative review

The elements that render anaesthesia a captivating profession can also foster stress and fatigue. Professionals considering anaesthesia as a career choice should have a comprehensive understanding of the negative consequences of fatigue and its implications for clinical performance and of the available preventive measures. Available evidence suggests that factors unrelated to patient characteristics or condition can affect clinical outcomes where anaesthetists are involved. Workload, nighttime work, and fatigue are persistent issues in anaesthesia and are perceived as presenting greater perioperative risks to patients. Fatigue seems to negatively affect both physical and mental health of anaesthetists. Existing evidence justifies specific interventions by institutions, stakeholders, and scientific societies to address the effects of anaesthetist fatigue. This narrative review summarises current knowledge regarding the effects of fatigue on anaesthetist well-being and patient safety, and discusses potential preventive solutions.

European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice

Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.

Peri-operative night-time work of anaesthesiologists: A qualitative study of critical issues and proposals

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.

Fatigue among anaesthesiologists in Europe: Findings from a joint EBA/NASC survey

BACKGROUND

Anaesthesiologists deliver an increasing amount of patient care and often work long hours in operating theatres and intensive care units, with frequent on-calls and insufficient rest in between. In the long term, this will negatively influence mental and physical health and well being. As fatigue becomes more prevalent, this has predictable implications for patient safety and clinical effectiveness. 1.

OBJECTIVE

This study aimed to evaluate the prevalence, severity, causes and implications of work-related fatigue amongst specialist anaesthesiologists.

DESIGN

An online survey of specialist anaesthesiologists.

PARTICIPANTS

The survey was sent to anaesthesiologists in 42 European countries by electronic mail.

MAIN OUTCOME MEASURES

Responses from a 36-item online survey assessed work-related fatigue and its impact on anaesthesiologists in European countries.

RESULTS

Work-related fatigue was experienced in 91.6% of the 1508 respondents from 32 European countries. Fatigue was caused by their working patterns, clinical and nonclinical workloads, staffing issues and excessive work hours. Over 70% reported that work-related fatigue negatively impacted on their physical and mental health, emotional well being and safe commuting. Most respondents did not feel supported by their organisation to maintain good health and well being.

CONCLUSION

Work-related fatigue is a significant and widespread problem amongst anaesthesiologists. More education and increased awareness of fatigue and its adverse effects on patient safety, staff well being and physical and mental health are needed. Departments should ensure that their rotas and job plans comply with the European Working Time Directive (EWTD) and introduce a fatigue risk management system to mitigate the effects of fatigue.

Nighttime working as perceived by Italian anesthesiologists: a secondary analysis of an international survey

BACKGROUND

No data are available on the working conditions and workload of anesthesiologists during perioperative nighttime work in Italy and on the perceived risks.

RESULTS

We analyzed 1085 responses out of the 5292 from the whole dataset. Most of the responders (76%) declared working a median of 12 consecutive hours during night shifts, with an irregular nightshift schedule (70%). More than half of the responders stated to receive a call 2-4 (40%) or 5 times or more (25%) to perform emergency procedures and/or ICU activities during night shifts. More than 70% of the responders declared having relaxation rooms for nighttime work (74%) but none to be used after a nightshift before going back home (82%) and no free meals, snacks, or beverages (89%). Furthermore, almost all (95%) of the surveyed anesthesiologists declared not having received specifical training or education on how to work at night, and that no institutional program has been held by the hospital to monitor fatigue or stress for night workers (99%). More than half of the responders stated having the possibility, sometimes (38%) or always (45%), to involve another colleague in difficult medical decisions and to feel comfortable, sometimes (31%) or always (35%), to call the on-call colleague. Participants declared that nighttime work affects their quality of life extremely (14%) or significantly (63%), and that sleep deprivation, fatigue, and current working conditions may reduce performance (67%) and increase risk for the patients (74%).

CONCLUSIONS

Italian anesthesiologists declare current nighttime practice to negatively affect their quality of life, and their performance, and are thus concerned for their patients' safety. Proper education on night work, starting from traineeship, and implementing institutional programs to monitor stress and fatigue of operators and to support them during nighttime work could be a mean to improve nighttime work conditions and safety for both patients and healthcare workers.