Sleep deprived doctors concerned about patient safety

Over a third of doctors say they feel sleep deprived on at least a weekly basis and over a quarter have been in a position where tiredness has impacted their ability to treat patients, a new survey by the Medical Defence Union (MDU) has found.

The UK’s leading medical defence organisation carried out the survey among its doctor members. Of 532 respondents one in four doctors (26%) said tiredness had affected their ability to safely care for patients, including almost 40 near misses and seven cases in which a patient actually sustained harm. In addition, six in ten respondents said their sleep patterns had worsened slightly or significantly during the pandemic.

Dr Matthew Lee, MDU chief executive, said:

“Doctors and their healthcare colleagues are running on empty. Our members have come through a period of immense pressure caused by the pandemic and it is affecting all aspects of their life, including sleep patterns. Previous studies have shown that fatigue can increase the risk of medical error and affect doctors’ health and wellbeing. In our survey, side effects doctors reported due to sleep deprivation included poor concentration (64%), decision making difficulties (40%), mood swings, (37%) and mental health problems (30%).

“Taking regular breaks is vital in the interests of doctors and their patients yet in our survey, three in ten doctors got no breaks at all during the working day despite many working long shifts. In addition, 21% didn’t have anywhere to go such as a staff room, or quiet area, to take a break.

“Pressures on frontline healthcare workers are likely to get worse for doctors in the coming weeks. At a time of considerable staff absence in the NHS it is more important than ever that those staff who are fit to work are properly supported so they can care for patients safely.”

Dr Michael Farquhar a consultant in paediatric sleep medicine at Evelina London Children’s Hospital, part of Guy’s and St Thomas’ NHS Foundation Trust, explained the dangers of doctors working when sleep deprived. He said:

“Even before the pandemic hit, fatigue was a huge issue in an NHS which a committee of MPs acknowledged to have been short of staff. Dealing with the impact of COVID has exacerbated significant issues which already existed, with many healthcare professionals ‘running on fumes’.

“Sleep deprived doctors can lose insight, meaning they can persevere when doing the wrong thing. Clinicians are more likely to make errors in simple repetitive tasks, such as calculating medication. Our ability to process, retain and analyse information suffers too which means it can take longer to assess a patient’s symptoms and reach a diagnosis. Crucially, fatigued clinicians driving home after a shift are at increased risk of significant road traffic accidents. With staff exhausted by two years of the pandemic, fatigue is a critical issue for both staff wellbeing and patient safety.”

The MDU says the government and NHS employers need to do more to ensure there are adequate resources in place to allow fatigued doctors to take regular breaks. The MDU offers support to doctors dealing with complaints and patient safety incidents including with the health and wellbeing issues that can arise.

What doctors told the MDU:

1. ‘The pandemic has significantly affected my sleep and resulted in ongoing exhaustion. I am now
2. considering whether to take early retirement.’
4. ‘I didn’t realise how tired I was until a near miss happened. I had to remove myself from the on-call rota as a result.’
6. ‘I have been in situations many times where I’ve struggled to drive home after a busy shift due to extreme tiredness.’

MDU survey findings:

• 9% of respondents felt sleep deprived on a daily basis and a further 28% on a weekly basis. This rose to 12% and 35% respectively among specialty training and career grade hospital doctors.
• 41% said sleep patterns had worsened slightly and 19% significantly during the pandemic.
• 26% said tiredness had impaired their ability to treat patients and 24% said tiredness may have played a part. Of these, 15% said there was a near miss and 3% that a patient was harmed.
• 29% got no breaks at all during a working day. For GPs this figure rose to 40%.
• 21% didn’t have anywhere at work to take a break.
• The most popular actions to combat tiredness were taking a short break (56%), drinking coffee/ other caffeine drink (55%), having a snack (37%) or taking exercise (34%). Mindfulness and breathing exercises were used by 16% of respondents.
• The most commonly reported impacts of tiredness included not looking after yourself (66%), poor concentration (64%) and difficulty switching off from work (61%).

The MDU surveyed a sample of doctors in December 2021. The 532 respondents (6% response rate) included: consultants & specialists (38%), GPs (33%) and specialty/career grade hospital doctors (27%).