Informal fatigue-related risk management in the emergency department: A trade-off between doing well and feeling well

Emergency physicians are known to be particularly vulnerable to sleep deprivation due to inconsistent shift rotation, extended duty periods and overnight calls. However, naturalistic studies have actually failed to systematically demonstrate that sleep deprivation is associated with poorer work performance in emergency physicians. The inconsistency of these results could reside in physicians' ability to compensate for fatigue-related impairments. Our aim is to assess the effectiveness of informal fatigue proofing (FPS) and reduction (FRS) strategies used by emergency physicians. We conducted a prospective longitudinal study with 28 emergency physicians (mean age 36.89 +/- 10.73 years, 11 females) for a total of 182 shifts. At enrollment, participants answered the Maslach Burnout Inventory and the Fatigue Management Survey. During shifts, we measured fatigue-related impairments using the Psychomotor Vigilance Task and work performance using an adapted version of the Physician Achievement Review. Of the four work performance dimensions addressed, patient interaction was the only one associated with decreased reaction time (F = 27.61, p < 0.001). Our findings revealed a significant interaction between reaction time and FPS frequency of use for the patient interaction (F = 4.91, p = 0.03) and self-management subscales (F = 5.92, p = 0.02). However, the frequency of use of FPS were found to be positively associated with early symptoms of burnout (beta = 0.79, p < 0.001). Finally, our results show that FRS frequency was associated with decreased reaction time (F = 8.02, p = 0.01) with no associated risk of burnout. We propose further considerations for the implementation and follow-up of a fatigue risk management system in the emergency department.