Examining aeromedical fatigue using clinical simulation: can we learn and adapt?
University Of Otago, Newtown, Wellington, New Zealand
Ms Julie Myers coordinates all research activity in the Occupational and Aviation Medicine Unit, which is known for its international distance teaching of aviation-related postgraduate qualifications. She is currently undertaking her own programme of PhD research focused on exploring the impact of fatigue on performance and safety in the aeromedical clinical environment.
Introduction: The critical care aeromedical setting is demanding and isolated, so even a small performance decrement could affect clinical care and patient safety. Fatigue is likely to affect clinicians in this setting, though the nature of the relationship between fatigue-related risk and impaired clinical performance is challenging to assess, and is not well understood. The objective of this work was to examine the influence of fatigue using high fidelity clinical simulation.
Methods: Critical care scenarios based on routine inter-facility air transfers were developed. Clinicians undertook two different scenarios (randomised crossover design), once when rested and once when fatigued. Trained assessors blinded to participants’ fatigue status assessed behaviours in four non-technical skills domains: teamwork, situational awareness, task management and decision making. Based on pre-defined criteria, expected behaviours were rated numerically from 5 (excellent) to 1 (completely absent or inadequate). Participants provided self-ratings of performance and fatigue impact after each simulation. De-brief opportunities using individual study videos were provided to clinicians when they had completed both simulation sessions. Rank-based statistical testing compared each clinician’s ‘rested’ and ‘fatigued’ scores.
Results: Early results show participants scored significantly higher on overall non-technical performance when rested versus fatigued (p = 0.007). Scores across individual domains of teamwork (p = 0.009), situational awareness (p = 0.007) and task management (p = 0.047) were consistently higher when rested; decision making scores did not differ (p = 0.181). However clinicians’ rating of their own performance did not differ between rested and fatigued states (p = 0.234). Anecdotal evidence suggested the de-brief provided a valuable opportunity to identify and discuss individual fatigue-related behaviours.
Discussion: Fatigue in this specialised critical care environment cannot always be prevented. However, its recognition in this type of acute and isolated patient care setting can lead to interventions to minimise its effects and optimise patient safety.