1
|
Ippolito M, Einav S, Giarratano A, Cortegiani A. Effects of fatigue on anaesthetist well-being and patient safety: a narrative review. Br J Anaesth 2024:S0007-0912(24)00149-1. [PMID: 38641516 DOI: 10.1016/j.bja.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Mariachiara Ippolito
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Sharon Einav
- Maccabi Healthcare Services Regional Director Hod HaSharon, Jerusalem, Israel; Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Antonino Giarratano
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anaesthesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Palermo, Italy.
| |
Collapse
|
2
|
Galvano AN, Ippolito M, Noto A, Lakbar I, Einav S, Giarratano A, Cortegiani A. Nighttime working as perceived by Italian anesthesiologists: a secondary analysis of an international survey. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2023; 3:32. [PMID: 37697413 PMCID: PMC10494393 DOI: 10.1186/s44158-023-00119-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/02/2023] [Indexed: 09/13/2023]
Abstract
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.
Collapse
Affiliation(s)
- Alberto Nicolò Galvano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy
| | - Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi", Policlinico "G. Martino," University of Messina, Messina, Italy
| | - Inès Lakbar
- Anesthesiology and Intensive Care, Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Sharon Einav
- General Intensive Care Unit of the Shaare Zedek Medical Centre and the Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.
- Department of Anaesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Via del Vespro 129, 90127, Palermo, Italy.
| |
Collapse
|
3
|
Cambonie G, Theret B, Badr M, Fournier P, Combes C, Picaud JC, Gavotto A. Birth during on-call period: Impact of care organization on mortality and morbidity of very premature neonates. Front Pediatr 2022; 10:977422. [PMID: 36061390 PMCID: PMC9433924 DOI: 10.3389/fped.2022.977422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The evidence that risks of morbidity and mortality are higher when very premature newborns are born during the on-call period is inconsistent. This study aimed to assess the impact of this situation among other determinants of outcomes, particularly newborn characteristics and care organization. METHODS Observational study including all infants born < 30 weeks' gestation in a French tertiary perinatal center between 2007 and 2020. On-call period corresponded to weekdays between 6:30 p.m. and 8:30 a.m., weekends, and public holidays. The primary endpoint was survival without severe morbidity, including grade 3-4 intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity. The relationship between admission and outcome was assessed by an adjusted odds ratio (aOR) on the propensity of being born during on-call period and expressed vs. weekday. Secondary analyses were carried out in extremely preterm newborns (<27 weeks' gestation), in cases of early death (within 7 days), and before (2007-2013, 51.5% of the cohort) vs. after (2014-2020, 48.5% of the cohort) the implementation of a pediatrician-nurse team dedicated to newborn care in the delivery room. RESULTS A total of 1,064 infants [27.9 (26.3; 28.9) weeks, 947 (760; 1,147) g] were included: 668 during the on-call period (63%) and 396 (37%) on weekdays. For infants born on weekdays, survival without severe morbidity was 54.5% and mortality 19.2%. During on-call, these rates were 57.3% [aOR 1.08 (0.84-1.40)] and 18.4% [aOR 0.93 (0.67-1.29)]. Comparable rates of survival without severe morbidity [aOR 1.42 (0.87-2.34)] or mortality [aOR 0.76 (0.47-1.22)] were observed in extremely preterm infants. The early death rate was 6.4% on weekdays vs. 8.2% during on-call [aOR 1.44 (0.84-2.48)]. Implementation of the dedicated team was associated with decreased rates of mortality [aOR 0.57 (0.38, 0.85)] and grade 3-4 IVH [aOR 0.48 (0.30, 0.75)], and an increased rate of severe BPD [aOR 2.16 (1.37, 3.41)], for infants born during on-call. CONCLUSION In this cohort, most births of very premature neonates occurred during the on-call period. A team dedicated to newborn care in the delivery room may have a favorable effect on the outcome of infants born in this situation.
Collapse
Affiliation(s)
- Gilles Cambonie
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infection, INSERM UMR 1058, University of Montpellier, Montpellier, France
| | - Bénédicte Theret
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Maliha Badr
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Patricia Fournier
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Clémentine Combes
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Jean-Charles Picaud
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| | - Arthur Gavotto
- Department of Neonatal Medicine, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, University of Montpellier, Montpellier, France
| |
Collapse
|
4
|
Cortegiani A, Ippolito M, Misseri G, Helviz Y, Ingoglia G, Bonanno G, Giarratano A, Rochwerg B, Einav S. Association between night/after-hours surgery and mortality: a systematic review and meta-analysis. Br J Anaesth 2020; 124:623-637. [DOI: 10.1016/j.bja.2020.01.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 01/11/2023] Open
|
5
|
Almeida M, Hanson AC, Alves MC. Burnout in physician faculty and its potential implications to medical education. J Clin Anesth 2019; 57:89-90. [DOI: 10.1016/j.jclinane.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 11/28/2022]
|
6
|
McClelland L, Plunkett E, McCrossan R, Ferguson K, Fraser J, Gildersleve C, Holland J, Lomas JP, Redfern N, Pandit JJ. A national survey of out-of-hours working and fatigue in consultants in anaesthesia and paediatric intensive care in the UK and Ireland. Anaesthesia 2019; 74:1509-1523. [PMID: 31478198 DOI: 10.1111/anae.14819] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2019] [Indexed: 11/30/2022]
Abstract
The tragic death of an anaesthetic trainee driving home after a series of night shifts prompted a national survey of fatigue in trainee anaesthetists. This indicated that fatigue was widespread, with significant impact on trainees' health and well-being. Consultants deliver an increasing proportion of patient care resulting in long periods of continuous daytime duty and overnight on-call work, so we wished to investigate their experience of out-of-hours working and the causes and impact of work-related fatigue. We conducted a national survey of consultant anaesthetists and paediatric intensivists in the UK and Ireland between 25 June and 6 August 2018. The response rate was 46% (94% of hospitals were represented): 84% of respondents (95%CI 83.1-84.9%) contribute to a night on-call rota with 32% (30.9-33.1%) working 1:8 or more frequently. Sleep disturbance on-call is common: 47% (45.6-48.4%) typically receive two to three phone calls overnight, and 48% (46.6-49.4%) take 30 min or more to fall back to sleep. Only 15% (14.0-16.0%) reported always achieving 11 h of rest between their on-call and their next clinical duty, as stipulated by the European Working Time Directive. Moreover, 24% (22.8-25.2%) stated that there is no departmental arrangement for covering scheduled clinical duties following a night on-call if they have been in the hospital overnight. Overall, 91% (90.3-91.7%) reported work-related fatigue with over half reporting a moderate or significantly negative impact on health, well-being and home life. We discuss potential explanations for these results and ways to mitigate the effects of fatigue among consultants.
Collapse
Affiliation(s)
- L McClelland
- Department of Intensive Care Medicine and Anaesthesia, Royal Gwent Hospital, Newport, UK
| | - E Plunkett
- Department of Anaesthesia, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - R McCrossan
- Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - K Ferguson
- Department of Anaesthesia, Aberdeen Royal Infirmary, Aberdeen, UK
| | - J Fraser
- Department of Paediatric Intensive Care, Bristol Royal Hospital for Children, Bristol, UK
| | - C Gildersleve
- Department of Paediatric Anaesthesia, Children's Hospital for Wales, Cardiff, UK
| | - J Holland
- Department of Anaesthesia, Princess of Wales Hospital, Bridgend, UK
| | - J P Lomas
- Department of Anaesthesia and Intensive Care, Bolton Foundation Trust, Bolton, UK
| | - N Redfern
- Department of Anaesthesia, Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | - J J Pandit
- Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| |
Collapse
|
7
|
McCrossan R, Stacey K, Redfern N. Time to extinguish burnout. Anaesthesia 2019; 74:1215-1218. [DOI: 10.1111/anae.14808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 01/29/2023]
Affiliation(s)
- R. McCrossan
- Department of Anaesthesia Royal Victoria Infirmary Newcastle‐upon‐Tyne NHS Foundation Trust Newcastle‐upon‐Tyne UK
| | - K. Stacey
- Department of Anaesthesia Imperial College Healthcare Trust LondonUK
| | - N. Redfern
- Department of Anaesthesia Royal Victoria Infirmary Newcastle‐upon‐Tyne NHS Foundation Trust Newcastle‐upon‐Tyne UK
| |
Collapse
|
8
|
Cumber E, Greig PR. Can a tool developed for industry be used to assess fatigue risk in medical rotas? A pilot study of foundation doctors' rotas in a tertiary centre. BMJ Open 2019; 9:e023470. [PMID: 30772847 PMCID: PMC6398646 DOI: 10.1136/bmjopen-2018-023470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the feasibility and ease of using a pre-existing health and safety executive fatigue risk calculator to assess doctors' rotas. DESIGN Observational. SETTING A large tertiary-referral teaching hospital in the UK. PARTICIPANTS 95 anonymised foundation years 1 and 2 rotas in General Medicine, General Surgery and Emergency Medicine covering a 4-month period. All rotas provided by rota coordinators were included and assessed. INTERVENTIONS Rotas were assessed for two indices: relative risk of fatigue-related errors compared with a '2-day, two-night, four-off' shift pattern and percentage chance of a high score on a standardised sleepiness scale. PRIMARY AND SECONDARY OUTCOME MEASURES Fatigue index (percentage chance of a high score on a standardised sleepiness scale) and risk index (relative risk of fatigue-related errors compared with a '2-day, two-night, four-off' shift pattern) of all shifts on all rotas. RESULTS Nearly half of all shifts demonstrated increased risk of fatigue-related errors and increased probability of high levels of sleepiness. There was significant interspeciality variation in both indices. These results are based on rotas as opposed to 'work as done' and are therefore likely to slightly universally underestimate actual fatigue risks. CONCLUSIONS This preliminary study demonstrates that this tool can be used to compare rotas and guide rota design to minimise risk wherever possible. The calculator guidance clearly states there is no 'ideal risk' but that values should be minimised, and a maximum fatigue risk agreed which is deemed acceptable given the nature of work undertaken. This study is intended to demonstrate that fatigue can and should be considered during rota design. We do not suggest that it is used to hold either individuals or organisations to account as there is no evidence for it being used in this way. Further work should assess the practicality of designing medical rotas using this tool to minimise fatigue risk.
Collapse
Affiliation(s)
| | - Paul Robert Greig
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| |
Collapse
|
9
|
Vargas-Prada S, Macdonald EB. Increased reporting of musculoskeletal pain in anaesthetists: is it an occupational issue? Anaesthesia 2019; 74:274-276. [PMID: 30657588 DOI: 10.1111/anae.14537] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- S Vargas-Prada
- Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.,Salus Occupational Health, Safety and Return to Work Services, NHS Lanarkshire, Hamilton, UK
| | - E B Macdonald
- Head of the Healthy Working lives Group, Healthy Working Lives Group, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Smith AF, Plunkett E. People, systems and safety: resilience and excellence in healthcare practice. Anaesthesia 2018; 74:508-517. [PMID: 30585298 PMCID: PMC6766951 DOI: 10.1111/anae.14519] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 11/28/2022]
Abstract
This article outlines recent developments in safety science. It describes the progression of three ‘ages’ of safety, namely the ‘age of technology’, the ‘age of human factors’ and the ‘age of safety management’. Safety science outside healthcare is moving from an approach focused on the analysis and management of error (‘Safety‐1’) to one which also aims to understand the inherent properties of safety systems that usually prevent accidents from occurring (‘Safety‐2’). A key factor in the understanding of safety within organisations relates to the distinction between ‘work as imagined’ and ‘work as done’. ‘Work as imagined’ assumes that if the correct standard procedures are followed, safety will follow as a matter of course. However, staff at the ‘sharp end’ of organisations know that to create safety in their work, variability is not only desirable but essential. This positive adaptability within systems that allows good outcomes in the presence of both favourable and adverse conditions is termed resilience. We argue that clinical and organisational work can be made safer, not only by addressing negative outcomes, but also by fostering excellence and promoting resilience. We outline conceptual and investigative approaches for achieving this that include ‘appreciative inquiry’, ‘positive deviance’ and excellence reporting.
Collapse
Affiliation(s)
- A F Smith
- Royal Lancaster Infirmary, Lancaster, UK
| | - E Plunkett
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
11
|
Noone P, Waclawski E. Fatigue risk management systems needed in healthcare. Occup Med (Lond) 2018; 68:496-498. [DOI: 10.1093/occmed/kqy101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Peter Noone
- Regional Occupational Health Service, Health Service Executive, North East
| | | |
Collapse
|
12
|
Stuetzle KV, Pavlin BI, Smith NA, Weston KM. Survey of occupational fatigue in anaesthetists in Australia and New Zealand. Anaesth Intensive Care 2018; 46:414-423. [PMID: 29966116 DOI: 10.1177/0310057x1804600411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Occupational fatigue in anaesthetists is recognised as a patient safety risk. Better understanding of the issues surrounding their fatigue is needed. This study aimed to ascertain the sources and effects of occupational fatigue amongst anaesthetists in Australia and New Zealand. An anonymous online survey was sent to 979 anaesthetists. The response rate was 38.0%. Most participants reported regularly working over 40 hours per week; men reported five more hours per week than women. Stated contributors to fatigue included long work hours, mental strain at work, and personal and family demands. Fatigue-related behaviour was reported more by men (OR [odds ratio]=2.6) and less by respondents reporting eight or more hours of sleep before work (OR=0.6). Reporting at least one instance of less than five hours off between shifts was predictive of falling asleep while administering an anaesthetic (OR=1.6). More data are required to support practices and policies that promote more time off between work periods and increased time for sleep to reduce risk of fatigue.
Collapse
|
13
|
Affiliation(s)
| | - A. Calo
- Velindre NHS Trust; Cardiff UK
| |
Collapse
|
14
|
McClelland L, Holland J, Lomas JP, Redfern N, Plunkett E. Trainee fatigue - time for a culture change? A reply. Anaesthesia 2017; 72:1563-1564. [DOI: 10.1111/anae.14127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - J. Holland
- University Hospital of Wales; Cardiff UK
| | | | - N. Redfern
- Newcastle Upon Tyne NHS Foundation Trust; Newcastle Upon Tyne UK
| | - E. Plunkett
- University Hospitals Birmingham NHS Foundation Trust; Birmingham UK
| |
Collapse
|
15
|
Affiliation(s)
- S. Swinkels
- Sunshine Coast University Hospital; Birtinya Australia
| |
Collapse
|
16
|
O'Shaughnessy SM, O'Donnell B. EWTD implementation in anaesthesia: effects on training and quality of life. Anaesthesia 2017; 72:1416-1417. [DOI: 10.1111/anae.14095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
17
|
Waclawski E, Noone P. Are aviation industry fatigue risk management strategies needed in healthcare? Anaesthesia 2017; 72:1417-1419. [DOI: 10.1111/anae.14096] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- E. Waclawski
- Occupational Health Unit; University of Edinburgh; Scotland
| | - P. Noone
- Occupational Health Service; Dublin North East Ireland
| |
Collapse
|
18
|
Affiliation(s)
- N. W. Penfold
- Department of Anaesthesia; West Suffolk Hospital; Bury St Edmunds Suffolk UK
| | - C. Carey
- Department of Anaesthesia; Brighton and Sussex University Hospital NHS Trust; Brighton Sussex UK
| |
Collapse
|