RCP: Junior doctors at increased risk of road traffic accidents when commuting

Thursday, 05, Oct 2006 12:00

A new survey from the Royal College of Physicians shows that junior doctors are at increased risk of road traffic accidents driving to and from work. The annual survey of Specialist Medical Registrars shows that 264 of 1619 doctors (16%) had a road traffic accident when commuting in 2004-5 – 134 when driving to work and 130 when returning from work - 74 after a day shift and 56 after a night shift.* These doctors work about one night in ten, so the return from a night shift is more risky, but international research shows that even driving to work can be a hazard if the driver is already exhausted.

Almost all junior doctors in England now work night shifts; nearly half are working seven night shifts in a row - the shift pattern with the highest risk of tiredness and making mistakes. Working at night is harder than working during the day because the body is programmed to be asleep. Working at night leads to loss of concentration, poorer decision-making, clinical errors and difficulty in learning. Shift workers who work several consecutive nights can become increasingly tired over the course of their duty.

Following the introduction of the European Working Time Directive (EWTD) in 2004, junior doctors are allowed to work no more than 56 hours per week on average, and from 2009 that will reduce to 48 hours. Although the EWTD was meant to reduce the problems arising from working long hours, implementation of the regulations has often involved little consideration of the safety and sleep requirements of junior doctors, with many suffering poorly designed rotas. The Department of Health has already issued advice that it is better to avoid rotas where junior doctors work seven nights in a row.

The Royal College of Physicians today launches a new report to help solve this problem, recommending three nine-hour shifts as the safest rota pattern to provide 24-hour cover. ‘Designing safer rotas for junior doctors in the 48-hour week’ was prepared on behalf of a multi-disciplinary working group by Nicholas Horrocks and Professor Roy Pounder, the RCP lead on the EWTD, and was produced with support from NHS National Workforce Projects.

The aim of the new guide is to highlight why certain rotas are more appropriate than others, and to provide suggestions on how to design safe and acceptable work schedules for doctors who must work at night. It includes detailed tables of how the various rotas can be organised and outlines the benefits and drawbacks of each, with a summary of relative risks of each rota. Practical tips are included, with the emphasis on involving staff and ensuring continuity of care for patients.

The three nine-hour shift pattern, for a maximum of three successive nights, has been chosen as the optimal as it has many advantages over other shift patterns:

• Shorter shifts lead to less exhaustion, this being safer for patient care

• Compared to two 13-hour shifts, the nine-hour shifts increases the proportion of hours worked in the day from 50% to 66%, providing fresher doctors in the peak demand times of late afternoon and early evening

• Working five nine-hour shifts on average each week gives doctors more regularity, and it increases opportunities for daytime teaching and supervision

• Nine-hour shifts are particularly suited to those posts with almost continuous intensive work such as A&E, acute medical take, critical care or neonatal unit

• NHS National Workforce Projects have now commissioned a pilot study of the new work pattern

‘Designing safer rotas for junior doctors in the 48-hour week’ is not only for hospital administrators but also for junior doctors, as it is crucial that doctors get involved in planning their own rotas. The new report is complementary to ‘Working the night shift: preparation, survival and recovery – a guide for junior doctors’ launched in February 2006, that gave particular advice about the hazards of driving when exhausted. Both reports are available to download free from the RCP website at:

http://www.rcplondon.ac.uk/pubs/brochure.aspx?e=180

Professor Ian Gilmore, President of the Royal College of Physicians, said:

“The bad news from our survey is that patient and doctor safety is being compromised by current junior doctor rotas, but the good news is that we have workable evidence-based solutions to offer acute hospitals around the country. These solutions must reach the frontline quickly.”

Dr Bob Coward, RCP Specialist Registrar Adviser, said:

“Half of the Specialist Registrars involved in acute medical care are working 7 consecutive nights, the majority with 13-hour shifts, resulting in a 91-hour week!! It is no surprise therefore that 86% were tired at work with 20% considering switching to a non-acute speciality and a further 15% to general practice. It is important that the DH follows up “Designing safer rotas” to see how implementation of this advice brings about improvement in working conditions and training for junior doctors, and better care for patients.”

Professor Roy Pounder, RCP lead on EWTD, said:

“The risk of accidents to workers increases with night shifts compared with daytime work; it increases with longer shifts, and also when working successive shifts. The most common pattern for junior physicians at the moment in England is to work seven 13-hour night shifts in succession – and this has to stop. The new guide suggests a much safer pattern of work, involving fewer nine-hour shifts in succession. This change, together with our earlier advice about surviving shift work, means those junior doctors should not only be safer and more effective when working night shifts, but their daily commute should be less hazardous.”

Dr Roger Duckitt, RCP Trainees Committee Communications Officer, said:

"Junior doctors are besieged by change, with the implementation of the European Working Time Directive and Modernising Medical Careers to name but two recent initiatives. For many it can feel as if their training is under threat, crushed between the demands of patient care and new working patterns. To many junior doctors, the benefit of these changes to patients is often not clear. Trainees want enough time to acquire the knowledge, and practice the skills required to provide their patients with high quality care. This publication underscores the importance of designing rotas that provide time for training while ensuring the safety of both patients and doctors. Finding this balance will improve job satisfaction, reduce fatigue and improve morale for junior doctors."

Notes to Editors:

The report will be launched with a press conference at the Royal College of Physicians at 11.00 am on Thursday 5 October 2006.

* Compared to similar drivers in their age group, Specialist Registrars are at a slightly higher risk of accidents than the general population, as measured by the Transport Research Laboratory – 0.0929 accidents per year per driver, compared to 0.078 accidents per year per driver for drivers of 10 years experience. The rate of accidents reported in this survey of junior doctors was 0.08 accidents per year – that was just commuting, and did not include all other driving.

TRL 317 The accident liability of company car drivers by P Lynn and C R Lockwood. Transport Research Laboratory. 1998.