Fatigue and its impact on performance and health.

An increasing body of evidence suggests that fatigue among healthcare staff is widespread, owing to a combination of high work intensity, long daytime hours and night-shift working. This has been linked to poorer outcomes for patients and longer inpatient stays, and to increased risks of work-related accidents, errors and injuries for practitioners. These include needlestick injuries and motor vehicle accidents, and other impacts on practitioner health, ranging from cancer, mental health problems, metabolic disorders to coronary disease. Other 24-hour safety-critical industries have fatigue policies that acknowledge the risks of staff fatigue and provide a system to manage it and mitigate harm, but these are still lacking within healthcare. This review explains the basic physiology behind fatigue and outlines its impacts on healthcare practitioners' clinical practice and wellbeing. It proposes methods to minimise these effects for individuals, organisations and the wider UK health service.