Doctors still working unsafe shifts in public hospitals

The AMA Safe Hours Audit 2011 shows that 53 per cent of Australian hospital doctors are working unsafe hours – classified as high risk or significant risk – with reports of continuous unbroken shifts of up to 43 hours.

AMA Vice President, Professor Geoffrey Dobb, said that State and Territory Governments and public hospital administrators must strengthen their efforts to support improved rostering and work practices for hospital doctors.

Professor Dobb, who works and teaches in a public hospital, said the AMA audit exposes work practices that contribute to doctor fatigue and stress levels that ultimately affect the quality of care and patient safety in the public hospital system.

The risks of fatigue have improved since the first AMA Safe Hours Audit in 2001, but reform of hospital work practices is too slow and inconsistent across the country.  In the 2006 audit, 62 per cent of respondents fell into the significant risk and higher risk categories, while in 2001 it was 78 per cent.

The AMA is pleased that there is an overall trend of continued improvement, but the 2011 audit clearly shows that extremes still exist and, in some cases, they have become worse.  For example:

• in 2011, 21 per cent of doctors had no days free from work during the audit period;
• the longest recorded shift increased from 39 hours in 2006 to 43 hours in 2011; and
• the maximum total number of hours worked during the audit week actually went up - from 113 in 2006 to 120 in 2011.

The average of total hours worked in the 2011 audit week for all hospital doctors was 55.1 hours.

Conducted in August 2011, the audit tabulated responses from more than 1486 public hospital doctors of all ages from all States and Territories.

The on-line audit collected data on the hours of work, on-call hours, non-work hours, and sleep time experienced by doctors working in the public hospital system over a full working week, and was independently analysed for the AMA.

The most stressed discipline is surgery, where 77 per cent of doctors fall into the significant risk and higher risk categories.

Even doctors in the lower risk category are working shifts of up to 19 hours, while the average longest periods of work at the significant risk and higher risk levels are similar to the 2006 audit results.

Professor Dobb said that long unbroken shifts can have a significant physical effect on people.

“The performance impairment of a person after 17 hours of sustained wakefulness has been shown to be equivalent to that at a blood alcohol concentration greater than 0.05 per cent,” Professor Dobb said.

“If this performance impairment was actually the result of alcohol consumption, prevailing hospital policies would prevent these doctors from working.

“It is not right to have doctors exposed to working conditions that could impair their performance.

“We need urgent action from governments and administrators to create and maintain safer working environments for doctors.

“Doctors don’t necessarily need to work fewer total hours in order to reduce the risks of fatigue.

“Often it is simply a case of smarter rostering practices and improved staffing levels so that doctors get a chance to recover from extended periods of work,” Professor Dobb said.

The Chair of the AMA Council of Doctors in Training (AMACDT), Dr Will Milford, said that fatigue has a big impact on the lives of junior doctors who are trying to juggle the competing demands of work, study and exams.

“Public hospitals are not just about service delivery,” Dr Milford said.

“They play an essential role in teaching and training, yet many doctors can get to a point where they are simply too tired to learn.

“We need to strike a much better balance so that we have a quality training environment that recognises teaching and training and the benefits that environment can bring to quality patient care,” Dr Milford said.

The AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors provides effective guidance on how to reduce the risks of fatigue.  The AMA believes that it should be adopted by all States and Territories as an absolute minimum.

The AMA Safe Hours Audit 2011 is at http://ama.com.au/ama-safe-hours-audit-2011

The AMA’s National Code of Practice – Hours of Work, Shiftwork and Rostering for Hospital Doctors is at http://ama.com.au/node/3756

13 July 2012

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                       Kirsty Waterford                    02 6270 5464 / 0427 209 753

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