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Wimpfheimer A, Weissman C, Fein S, Ginosar Y. When policy meets reality: the new 18-hour on-call shift policy and the Israeli anesthesia workforce crisis. Isr J Health Policy Res 2023; 12:8. [PMID: 36859390 PMCID: PMC9977473 DOI: 10.1186/s13584-023-00556-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The Israeli physician workforce faces multiple challenges. These include planned policies reducing physician on-call from 26 to 18 h and, from 2026, allowing only graduates of Ministry of Health approved foreign medical schools to take the Israeli licensing examination and an ongoing physician shortage (2019: Israel had 3.19 physicians/1000 persons vs. OECD average of 3.49 physicians/1000 persons). This study examines the potential impact of these planned policies on the Israeli anesthesiology workforce. METHODS Surveys conducted among 34 public and private Israeli hospital anesthesiology department chairs collected data on their department's number of weekday on-call anesthesiologists and current shortage of anesthesiologists. A subsequent survey collected data on each anesthesiologist in the workforce, including the country where they studied medicine. RESULTS Each weekday night there were 114 on-call anesthesiologists; 72 residents and 42 attendings. Using productive work coefficients, this translates to 104 resident and 51 attending anesthesiologists. Furthermore, 21 departments had existing anesthesia workforce shortages totaling 110 anesthesiologists. There were 873 anesthesiologists from non-OECD countries whose medical schools are not accredited by the World Federation for Medical Education, of whom 332 were residents (61.9% of residents). Only 20.1% of anesthesiology residents were Israeli medical school graduates. CONCLUSIONS Descriptive survey data assessed the immediate and long-term consequences for the healthcare system and anesthesiology workforce of two new Health Ministry policies. Implementing the 18-h policy will immediately remove from the daytime workforce 155 anesthesiologists and who will be unavailable to staff elective surgery operating rooms. This will compound the current national shortage of 110 anesthesiologists. It is unclear how to replace this shortfall since there are no surplus Israeli physicians and very few Israeli graduates choose anesthesiology as a specialty. This situation will be exacerbated after 2026 when graduates of certain foreign medical schools will be unable to enter the medical workforce, further reducing the pool of potential anesthesiology residents. Both policies were promulgated without adequate operational and budgetary planning or fiscal or workforce resources; implementation of the 18-h on-call policy has already been postponed. Therefore, new or updated policies must be accompanied by specific operational plans, budgetary allocations and funds for additional workforce.
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Affiliation(s)
- Ariel Wimpfheimer
- Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Braun School of Public Health, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Charles Weissman
- Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel.
- Hospital Administration, Hadassah-Hebrew University Medical Center, Kiryat Hadassah, POB 12000, 91120, Jerusalem, Israel.
| | - Shai Fein
- Department of Anesthesia and Operating Rooms, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Ginosar
- Faculty of Medicine of the Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Scholliers A, Cornelis S, Tosi M, Opsomer T, Shaproski D, Vanlersberghe C, Vanhonacker D, Poelaert J, Goudman L, Moens M. Impact of fatigue on anaesthesia providers: a scoping review. Br J Anaesth 2023; 130:622-635. [PMID: 36697276 DOI: 10.1016/j.bja.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 09/01/2022] [Accepted: 12/15/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Recently, fatigue has received more attention as a workplace hazard. This scoping review focuses on fatigue in anaesthesia providers. We explore the prevalence of fatigue in anaesthesia providers, and we examine how fatigue impacts their performance. METHODS A literature search was independently conducted from December 2019 through March 2020. The following four databases were consulted: MEDLINE, CINAHL, EMBASE, and PubPsych. Only studies discussing fatigue in anaesthesia providers were eligible. RESULTS The initial database search identified a total of 118 studies, of which 30 studies were included in the review. Eight articles concerned the prevalence of fatigue in anaesthesia providers, whereas 22 explored the impact of fatigue on the performance of anaesthesia providers. Up to 60.8% of anaesthesia providers suffered from severe excessive daytime sleepiness, and fatigue was denoted as a common workplace problem in up to 73.1% of anaesthesia providers. Fatigue had a negative influence on medication errors and vigilance, and it decreased the performance of anaesthesia providers during laboratory psychomotor testing. There was a decrease in non-technical skills (notably communication and teamwork) and worsening mood when fatigued. CONCLUSIONS Based on this scoping review, fatigue is a prevalent a phenomenon that anaesthesia providers cannot ignore. A combination of deterioration in non technical skills, increased medication errors, loss of sustained attention, and psychomotor decline can lead to poorer performance and cause patient harm. Concrete strategies to mitigate fatigue should be developed.
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Affiliation(s)
- Annelies Scholliers
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium.
| | - Stef Cornelis
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Maurizio Tosi
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Tine Opsomer
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - David Shaproski
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Caroline Vanlersberghe
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Domien Vanhonacker
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology and Perioperative Medicine, University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Lisa Goudman
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, University Hospital Brussels (UZ Brussel), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Research Foundation-Flanders (FWO), Brussels, Belgium
| | - Maarten Moens
- STIMULUS Research Group, Vrije Universiteit Brussel, Brussels, Belgium; Department of Neurosurgery, University Hospital Brussels (UZ Brussel), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium; Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Radiology, University Hospital Brussels (UZ Brussel), Brussels, Belgium
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Anteby R, Petrusa E, Ferrone CR, Mullen JT, Phitayakorn R. Which Patient Do I Attend to First? Night-float Simulation to Assess Surgical Intern's Clinical Prioritization Skills. JOURNAL OF SURGICAL EDUCATION 2021; 78:e226-e231. [PMID: 34366286 DOI: 10.1016/j.jsurg.2021.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Night-float rotations require general surgery interns to prioritize multiple competing patients' needs efficiently and accurately. Research is lacking on whether these skills can be taught and to what degree the prioritizations taught match overall attending surgeon expectations. DESIGN A night-float situation was developed to simulate the experience of surgical interns responding to multiple patients' needs. Participants were instructed to rank order 10 patient paper-case scenarios with a variety of clinical urgencies. After completing their first ranking, the interns participated in a faculty-facilitated peer discussion (intervention) and were then instructed to re-rank their priorities. Their performance was compared pre- and post-intervention, and to the ranking of 16 surgery faculty attendings. SETTING Massachusetts General Hospital, Department of Surgery, Boston, MA. PARTICIPANTS Post-graduate year (PGY) 1 surgical residents. RESULTS Two classes of general surgery interns (n = 25) completed the prioritization training simulation in the middle of their internship year, one class in 2018 and one in 2020. Agreement between interns regarding patient prioritization ranking increased after the facilitated peer discussion (pre-intervention mean standard deviation = 1.8 versus 0.9 post-intervention; p = 0.03). In the post-intervention mean rank, four cases moved by one position (p < 0.05). The facilitated discussion resulted in increased absolute agreement between individual interns and attendings' ranks (mean agreement 38 ± 17% pre-intervention Vesus mean 50 ± 20% post-intervention, p = 0.02). The scenarios with highest agreement between interns and attendings concerned patients with the most urgent conditions. Scenarios with the lowest agreement were those ranked with medium-to-low urgency. CONCLUSION A faculty-led facilitated discussion appears to increase clinical prioritization consistency among surgical interns and better align their prioritizations with expectations of local attending surgeons.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; School of Public Health, Harvard University, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Insufficient sleep among Anaesthesiologists and Intensive Care Physicians: It's time to wake up! Anaesth Crit Care Pain Med 2020; 39:749-751. [PMID: 33002668 PMCID: PMC7521889 DOI: 10.1016/j.accpm.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A review of current approaches for evaluating impaired performance in around-the-clock medical professionals. Sleep Med Rev 2019; 46:97-107. [PMID: 31102878 DOI: 10.1016/j.smrv.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 03/19/2019] [Accepted: 04/10/2019] [Indexed: 01/16/2023]
Abstract
The need for data to study the relationship between fatigued healthcare professionals and performance outcomes is evident, however, it is unclear which methodology is most appropriate to provide these insights. To address this issue, we performed a systematic review of relevant articles by searching the MEDLINE, EMBASE, Cochrane, Web of Science, and CINAHL databases. The literature search identified 2960 unique references, of which 82 were identified eligible. The impact on performance was studied on clinical outcomes, medical simulation, neurocognitive performance, sleep quantification and subjective assessment. In general results on performance are conflicting; impairment, no effect, and improvement were found. This review outlines the various methods currently available for assessing fatigue-impaired performance. The contrasting outcomes can be attributed to three main factors: differences in the operationalisation of fatigue, incomplete control data, and the wide variety in the methods used. We recommend the implementation of a clinically applicable tool that can provide uniform data. Until these data become available, caution should be used when developing regulations that can have implications for physicians, education, manpower planning, and ‒ ultimately ‒ patient care.
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Abstract
Objectives: To quantify fatigue risk and sleepiness among anesthesia residents in Saudi Arabia (SA). Methods: Between April 2014 and April 2015, all anesthesia residents training in western, central, and eastern regions in SA were invited to fill a survey. We conducted a cross-sectional self-reporting survey that included demographic data, the Epworth sleepiness scale (ESS), and 2 other scales to assess fatigue risk: a Checklist for Individual Strength (CIS) and a predefined comprehensive fatigue risk assessment previously developed by the Australian Medical Association (AMA). Results: We received 102 responses, and more than half of the individuals in the sample were at elevated risk of fatigue according to both fatigue scales. Approximately 70% reported being excessively sleepy during the day. Conclusion: All 3 scales used in our survey suggested that local anesthesia residents in SA are sleepy and at risk of becoming fatigued. This could be multifactorial, explained by long shifts, or cultural and lifestyle habits.
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Affiliation(s)
- Abeer A Arab
- Department of Anesthesia & Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Aran A, Wasserteil N, Gross I, Mendlovic J, Pollak Y. Medical Decisions of Pediatric Residents Turn Riskier after a 24-Hour Call with No Sleep. Med Decis Making 2016; 37:127-133. [DOI: 10.1177/0272989x15626398] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/12/2015] [Indexed: 11/16/2022]
Abstract
Background. Despite a gradual reduction in the workload during residency, 24-hour calls are still an integral part of most training programs. While sleep deprivation increases the risk propensity, the impact on medical risk taking has not been studied. Objective. This study aimed to assess the clinical decision making and psychomotor performance of pediatric residents following a limited nap time during a 24-hour call. Methods. A neurocognitive battery (IntegNeuro) and a medical decision questionnaire were completed by 44 pediatric residents at 2 time points: after a 24-hour call and following 3 nights with no calls (sleep ≥5 hours). To monitor sleep, residents wore actigraphs and completed sleep logs. Results. Nap time during the shift was <1 hour in 14 cases (32%), 1 to 2 hours in 16 cases (35%), and 2 to 3 hours in 14 cases (32%). Residents who napped less than 1 hour chose the riskier medical option in 50% of cases compared with 36% when answering the same questionnaire after 3 nights with no calls ( P = 0.002). This effect was not found in residents who napped 1 to 2 hours (no change in risk taking) or 2 to 3 hours (4% decreased risk taking) (difference between groups, P = 0.001). Risk-taking tendency inversely correlated with sustained attention scores (Pearson = −0.433, P = 0.003). Sustained attention was the neurocognitive domain most affected by sleep deprivation (effect size = 0.29, P = 0.025). Conclusions. This study suggests that residents napping less than an hour during a night shift are prone to riskier clinical decisions. Hence, enabling residents to nap at least 1 hour during shifts is recommended.
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Affiliation(s)
- Adi Aran
- Shaare Zedek Medical Center, Jerusalem, Israel (AA, NW, JM)
- Hadassah Medical Center, Jerusalem, Israel (IG)
- School of Education, Hebrew University, Jerusalem, Israel (YP)
| | - Netanel Wasserteil
- Shaare Zedek Medical Center, Jerusalem, Israel (AA, NW, JM)
- Hadassah Medical Center, Jerusalem, Israel (IG)
- School of Education, Hebrew University, Jerusalem, Israel (YP)
| | - Itai Gross
- Shaare Zedek Medical Center, Jerusalem, Israel (AA, NW, JM)
- Hadassah Medical Center, Jerusalem, Israel (IG)
- School of Education, Hebrew University, Jerusalem, Israel (YP)
| | - Joseph Mendlovic
- Shaare Zedek Medical Center, Jerusalem, Israel (AA, NW, JM)
- Hadassah Medical Center, Jerusalem, Israel (IG)
- School of Education, Hebrew University, Jerusalem, Israel (YP)
| | - Yehuda Pollak
- Shaare Zedek Medical Center, Jerusalem, Israel (AA, NW, JM)
- Hadassah Medical Center, Jerusalem, Israel (IG)
- School of Education, Hebrew University, Jerusalem, Israel (YP)
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Makhani A, Akbaryan F, Cernak I. Cognitive performance improvement in Canadian Armed Forces personnel during deployment. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2015. [DOI: 10.3138/jmvfh.2014-04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Chronic stress can decrease resilience and diminish cognitive adaptability; thus, operational stressors related to military deployment can pose significant risks to cognitive functioning. Numerous studies have aimed to assess the effects of deployment on cognitive functioning on the basis of cognitive performance measures administered before and after deployment. However, to the best of our knowledge, no studies have measured neurocognitive performance of military personnel while they were deployed to a combat zone. Methods: Canadian Armed Forces military troops ( N = 85) were tested during pre-deployment training and during deployment in Afghanistan. At both time points, the participants completed a detailed demographic form and performed touch-screen neurocognitive tests using the Cambridge Neuropsychological Test Automated Battery (CANTAB). The CANTAB measurements included executive function (Attention Switching Task [AST] and Spatial Working Memory [SWM] test), decision making and response control (Stop Signal Task [SST]), and attention (Reaction Time [RTI] test). Two-tailed, paired t-tests were used to compare pre-deployment and deployment CANTAB results. Results: On average, all participants significantly improved their performance on all neurocognitive tests during deployment compared with pre-deployment. At both pre-deployment and deployment time points, the participants demonstrated excellent performance on the AST and RTI test and less-than-optimal performance on the SWM test and SST. Discussion: The influence of training, social factors, and emotional status, among many others, on cognitive adaptability should be taken into account to fully understand soldiers’ capability to improve and maintain high cognitive functioning during deployment.
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Affiliation(s)
- Asad Makhani
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Farzad Akbaryan
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ibolja Cernak
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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