A survey of more than 4,000 UK emergency care doctors has shown that they need more support to recover from work pressures between shifts. The study highlighted how the doctors' “need for recovery” was higher than anything recorded in previous studies of a similar nature — and could be helped by factors such as reducing the number of antisocial shift patterns and improving access to leave.
Led by a newly formed Trainee Emergency Research Network, sponsored by University Hospitals Plymouth NHS Trust (UHPNT), and with collaboration from the University of Plymouth and the Royal College of Emergency Medicine, the research asked a total of 4,247 doctors in emergency departments from 112 National Health Service (NHS) Trusts around the UK to complete a validated Need for Recovery (NFR) Scale. This 11-item questionnaire assesses how work affects inter-shift recovery, with items compiled to form a score between 0 and 100.
The median average NFR result was 70 – higher than any scores reported in other professions or populations to date.
In addition, a higher proportion of antisocial working was associated with a higher NFR score, suggesting that any reduction in antisocial shifts could help improve wellbeing. Known as the TIRED study, it was the largest healthcare study to date of a tool that assesses the need for staff to physically and psychologically recuperate following a period of work. The authors also propose that the use of this tool could identify staff wellbeing issues before they progress to burnout.
The research took place in 2019 before the COVID-19 pandemic, but authors suggest the study findings remain relevant given that pressures on emergency care doctors are only likely to have increased.
Lead author Dr Laura Cottey, chief investigator for the Trainee Emergency Research Network study, said: "We all know that emergency care can be a high-pressure environment, but these results provide the evidence of the impact this work demand is having on staff wellbeing. Previous Need for Recovery scores among a variety of population groups were reported between 36 and 44, so for the median score to be 70 among over 4,000 doctors is definitely something that needs to be addressed.
"Among our respondents, we saw that NFR scores were increased by difficulty accessing annual and study leave, as well as an increased proportion of antisocial working – such as night shifts. Better access to leave and any reduction in antisocial shifts might result in direct improvements in NFR and help protect against the development of burnout."
Co-author Dr Blair Graham, lecturer in urgent and emergency care at the University of Plymouth and specialty registrar in emergency medicine at UHPNT, said: "The first step to overcoming any problem is recognising that there is one – so having these results is a good start. Even if fewer antisocial shifts cannot be achieved, acknowledgement of a problem and the provision of rest facilities may help to mitigate the issue.
"The next step would be for us to carry out the research at different times of year to understand whether the results are seasonal, or affected by other factors. Although this study was conducted prior to COVID-19 arriving in the UK, we believe the findings still need to be taken into account as pressures on emergency care doctors are only likely to have increased during the pandemic."
Professor Gary Minto, director of research and development at UHPNT, said: "Here at University Hospitals Plymouth, our research strategy is that, in addition to our longstanding strength in running clinical trials, we also expand our focus into other areas of social care, health and wellbeing. The TIRED study, which addresses mental health in Emergency Doctors, is a great example. This prominent nationwide study, initiated, led and delivered by doctors in training contains important messages about downtime and shift patterns which are relevant across the UK, particularly as the COVID-19 situation evolves."
Objectives: To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.
Design: Cross-sectional electronic survey.
Setting: Emergency departments (EDs) (n=112) in the UK and Ireland.
Participants: Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.
Main outcome measure: NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.
Results: The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5–90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%–50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%–75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%–100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).
Conclusion: Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.
Laura Cottey, Tom Roberts, Blair Graham, Daniel Horner, Kara Nicola Stevens, Doyo Enki, Mark David Lyttle, Jos Latour
[link url="https://www.plymouth.ac.uk/news/emergency-care-doctors-not-getting-sufficient-down-time-new-study-shows"]University of Plymouth material[/link]
[link url="https://bmjopen.bmj.com/content/10/11/e041485"]BMJ Open full text[/link]