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Short Rest Solutions In Health Care Settings

In 2018, the British Medical Association issued a series of recommendations to improve rest facilities and reduce fatigue among healthcare workers. Among these, a case was made for the adoption of sleep pods based on extensive research conducted in the US quantifying the benefits of naps in the medical environment.[i] This call for health trusts to take better care of their staff came after multiple cases of junior doctors reporting burnout, an increase in mental health issues, and car crashes following prolonged work hours. Specifically, the case of junior doctor Lauren Connelly, who was involved in a fatal road accident after a 12-hour night shift and having worked 107 hours in 12 days, sparked a conversation among politicians and the public alike, who demanded NHS action.[ii] In May 2019, the Government announced a £10 million investment to upgrade or install facilities such as sleep pods for the purpose of reducing fatigue and improving wellbeing of hospital staff.[iii]

Sleep Deprivation and Patient Safety

Fatigue can negatively affect the psychomotor and cognitive performance of practitioners, resulting in impaired decision making and reduced alertness.[iv] Studies conducted among nightshift workers found attention failures to occur at more than double the rate compared to non-extended shifts, and the risk of medical errors three times higher.[v] [vi] Medical interns were found to commit 5.6 times more serious diagnostic errors and 20.8% more serious medication errors during shifts of 24 hours or more.[vii] The latter have led to an estimated 712 deaths in England every year, and are a contributing factor in 1,700 to 22,303 deaths per year, according to a report from the Universities of York, Manchester and Sheffield. Further, they cost the economy £98.5 million per year.[viii] Lastly, sleep deprivation has been identified as main cause of decision regret among nurses in critical care, where they deal with patients particularly vulnerable to medical errors[ix].

20.8%
more serious medication errors during shifts of 24+ hours
5.6x
more serious diagnostic errors commited during long shifts
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Sleep Deprivation and Road Safety

Sleep deprivation can be dangerous for medical staff due to higher risk of road accidents or ‘near misses’ following long shifts. The risk increases by 9.1% with each extended shift per month.[x] [xi] In the UK, 2 in 5 doctors have fallen asleep at the wheel while driving home after a night shift and more than 55% of trainee anaesthetists had or came close to having an accident after working all night.[xii] In an online survey from Doctors.net.uk, one in four respondents reported knowing a colleague who tragically died in a road accident after a night shift. Though falling asleep at the wheel is an issue concerning all health professionals, junior doctors are a category particularly at risk. Having to relocate every 3-4 months, they face longer commutes at an average of 25 miles.[xiii]

2 in 5
doctors have fallen asleep at the wheel after a nightshift.

Sleep Deprivation and Mental Wellbeing

Long working hours impose a significant toll on the mental health of healthcare practitioners, whose rates of psychological distress and suicide attempts are higher than other professions. A survey carried out by the British Medical Journal found 31.5% of doctors experience high burnout, while 26.2% high levels of traumatic stress.[xiv] Similarly, 14% of respondents to a Medscape survey reported feeling consistently depressed, compared to a 3.3% of the general population, and identified their job and the long working hours as the main cause for their low mood. For 66% of the doctors, the burnout had continued for at least a year and 12% found it to be so severe as to make them consider leaving medicine altogether.[xv]

The COVID-19 pandemic has, according to an enquiry conducted by the BMA, exacerbated these issues, with 44% of doctors suffering from depression, anxiety, stress or other mental health conditions relating to or made worse by their work.[xvi] If untreated, persistent low mood and stress can result in suicide, which is unfortunately widespread in the medical profession. Between 2011 and 2015, 430 doctors took their own life in England, which averages two deaths a week.[xvii] Female doctors have been found to be particularly vulnerable, with a rate 2.5-4.0 times higher than the general population.[xviii]

44%
doctors suffering from depression, anxiety or stress caused by their job
2 a week
doctors taking their own lives on average between 2011 and 2015
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Benefits of Short Rest

15-minute naps have been linked to improved performance and alertness for a period of up to three hours. Further, naps were found to increase attention to detail and promote better decision making in physicians and nurses working in the Emergency Department.[xix] For staff driving home after a night shift, taking a short nap reduces drowsiness as well as reducing the need for recovery sleep after work.[xx] [xxi] Lastly, short rest has been found effective in improving mental states by increasing feelings of relaxation, and relieving stress even after a disrupted night’s sleep.[xxii] [xxiii]

The Podtime Sleep Pod

The Podtime sleep pods represents an innovative, space efficient solution to more traditional strategies such as on-call rooms, chairs or mattresses. Thanks to its unique and compact design, it enables the conversion of virtually any space into a rest area by providing the user with privacy and quiet.  It has been widely adopted by healthcare organizations supporting their staff working on-call, providing a space for sleep during or following (night) shifts.

The Anaesthetic department at North Bristol Trust in Southern England bought two Original Pods following the loss of dedicated on-call rooms. Installed in March 2020, they have generated considerable interest and have been widely used.

“On a practical level, the pods are very comfortable to rest in. Trainees have reported being able to quickly ‘switch off’ and fall asleep in them. They are not claustrophobic and have a semi-opaque closing system, which can be left partly open if so wished. There is a small shelf to put personal possessions on, and a small lamp. The pods allow individuals to sleep in a quiet and private space. Clean linen and a bin for used linen are adjacent to the office.”

David Cronin, Anaesthetic Fellow - North Bristol NHS Trust

Similarly, Guy’s and St Thomas’ Hospital Trust in London implemented a series of health and wellbeing initiatives to support its under-pressure staff during the coronavirus pandemic. Rest and recharge zones have been created and 20 sleep pods have been installed. In addition, massage chairs, exercise bikes, aromatherapy, free magazines, cool drinks and snacks have been provided. 

In late 2020, Lancashire Teaching Hospital received a charitable donation by a local business for the purchase of state-of-the-art facilities to support staff during the COVID-19 pandemic. The 6 sleep pods are part of a wider effort to improve wellbeing through the creation of dedicated rest and recreation spaces, which include a kitchen, new female changing, breastfeeding rooms for nursing staff and shower facilities.

”I know that they all want to be the very best they can be when dealing with patients, and so as they face this second peak, having had very little time to recuperate from the last one, I am delighted that we will be able to provide amazing facilities such as these - which wouldn’t look out of place in a Dubai airport lounge.”

Paula Wilson, Head of Charity and Fundraising, Lancashire Teaching Hospitals NHS Trust

Other trusts which have adopted the Podtime solutions to support their key workers include the Cwm Taf Morgannwg University Health Board in Wales, which purchased sleep pods for three of its hospitals, Imperial College Healthcare NHS Trust in London, Newcastle Upon Tyne Hospitals, Luton and Dunstable University Hospital, and Milton Keynes University Hospital.

Notes & References

[i] Rimmer, A. (2018). Urgent action is needed to manage doctors’ fatigue, says BMA. BMJ, k127. doi: 10.1136/bmj.k127

[ii] Mortimer, C. (2015). Junior Doctors work 100 hours before they get a day off. The Independent. Retrieved from: https://www.independent.co.uk/life-style/health-and-families/health-news/scottish-junior-doctors-work-100-hours-before-they-get-a-day-off-a6690696.html

[iii] BMA (2019). BMA – New funding for hospital rest facilities is welcome as many are fundamentally unsafe, says BMA. Retrieved here: https://thecareruk.com/funding-for-hospital-rest-facilities-is-welcome-as-many-are-unsafe-says-bma/

[iv] Smith-Coggins, R., Rosekind, M., Hurd, S., & Buccino, K. (1994). Relationship of day versus night sleep to physician performance and mood. Annals Of Emergency Medicine, 24(5), 928-934. doi: 10.1016/s0196-0644(94)70209-8 

[v] Rogers, A., Hwang, W., Scott, L., Aiken, L., & Dinges, D. (2004). The Working Hours Of Hospital Staff Nurses And Patient Safety. Health Affairs, 23(4), 202-212. doi: 10.1377/hlthaff.23.4.202

[vi] Lockley, S., Cronin, J., Evans, E., Cade, B., Lee, C., & Landrigan, C. et al. (2005). Effect of Reducing Interns’ Weekly Work Hours on Sleep and Attentional Failures. Obstetrical & Gynecological Survey, 60(4), 226-228. doi: 10.1097/01.ogx.0000157053.65669.09

[vii] Landrigan, C., Rothschild, J., Cronin, J., Kaushal, R., Burdick, E., & Katz, J. et al. (2004). Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units. New England Journal Of Medicine, 351(18), 1838-1848. doi: 10.1056/nejmoa041406

[viii] Elliott R, Camacho E, Campbell F, Jankovic D, Martyn St James M, Kaltenthaler E, Wong R, Sculpher M, Faria R, (2018). Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK.  Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York.

[ix] Scott, L. D., Rogers, A. E., Hwang, W., & Zhang, Y. (2006). Effects of Critical Care Nurses’ Work Hours on Vigilance and Patients’ Safety. Americal Journal of Critical Care, 15(1), 30-37. doi: 10.4037/ajcc2006.15.1.30

[x] Borges, F.N., Fischer, F.M., Rotenberg, L., Soares, N.S., Fonseca, M.B., Smolensky, M.H. et al. (2009). Effects of naps at work on the sleepiness of 12-hour night shift nursing personnel. Sleep Science, 2(1), 24-29.

[xi] Brown, J. G., Sagherian, K., Zhu, S., Wieroniey, M., Blair, L., Warren, J. et al. (2016). Napping on the Night Shift: a Two-Hospital Implementation Project. Americal Journal of Nursing, 116(5), 26-33. doi: 10.1097/01.NAJ.0000482953.88608.80.

[xii] Campbell, D. (2017). Half of junior doctors having accidents or near misses after night shifts. The Guardian. 

[xiii] Johnson, S. (2016). ‘I fell asleep at the wheel’: the dangers of doctors driving home. The Guardian. Retrieved from https://www.theguardian.com/healthcare-network/2016/jul/26/two-in-five-doctors-fallen-asleep-wheel-night-shift

[xiv] McKinley N, McCain RS, Convie L, et al (2020). Resilience, burnout and coping mechanisms in UK doctors: a cross-sectional study BMJ Open. doi: 10.1136/bmjopen-2019-031765

[xv] Locke, T. (2018). Medscape UK Doctors’ Burnout & Lifestyle Survey 2018. Medscape. 

[xvi] BMA (2020). Almost half of UK doctors suffering from burnout, depression or anxiety, BMA survey reveals. Retrieved from https://www.bma.org.uk/news-and-opinion/almost-half-of-uk-doctors-suffering-from-burnout-depression-or-anxiety-bma-survey-reveals

[xvii] Windsor-Shellard, Dr., B. (2017). Suicide by occupation: England, age-specific counts – Office for National Statistics. Retrieved from https://www.ons.gov.uk/

 [xviii] Gerada, C. (2018). Doctors and suicide. British Journal Of General Practice, 68(669), 168-169. doi: 10.3399/bjgp18x695345

[xix] Smith-Coggins, R., Howard, S., Mac, D., Wang, C., Kwan, S., & Rosekind, M. et al. (2006). Improving Alertness and Performance in Emergency Department Physicians and Nurses: The Use of Planned Naps. Annals Of Emergency Medicine, 48(5), 596-604.e3. doi: 10.1016/j.annemergmed.2006.02.005 

[xx] Richardson, G., Miner, J., & Czeisler, C. (1990). Impaired driving performance in shiftworkers: The role of the circadian system in a multifactorial model. Journal Of Safety Research, 21(4), 167. doi: 10.1016/0022-4375(90)90033-8 

[xxi] Barger, L., Cade, B., Ayas, N., Cronin, J., Rosner, B., Speizer, F., & Czeisler, C. (2005). Extended Work Shifts and the Risk of Motor Vehicle Crashes among Interns. New England Journal Of Medicine, 352(2), 125-134. doi: 10.1056/nejmoa041401 

[xxii] Brice Faraut, Samir Nakib, Catherine Drogou, Maxime Elbaz, Fabien Sauvet, Jean-Pascal De Bandt, Damien Léger. Napping Reverses the Salivary Interleukin-6 and Urinary Norepinephrine Changes Induced by Sleep Restriction. The Journal of Clinical Endocrinology & Metabolism, 2015; jc.2014-2566 DOI: 10.1210/jc.2014-2566 

[xxiii] Luo, Z., & Inoue, S. (2000). A short daytime nap modulates levels of emotions objectively evaluated by the emotion spectrum analysis method. Psychiatry And Clinical Neurosciences, 54(2), 207-212. doi: 10.1046/j.1440-1819.2000.00660.x