Determinants of fatigue in emergency department clinicians who wear personal protective equipment

• Published in: Emergency medicine Australasia Vol. 36; no. 1; pp. 39 - 46
• Main Authors: Bodnar, Daniel, Brown, Nathan J, Mitchell, Gary, Hughes, James A, Lourensen, Darren, Hawkins, Tracey, Chu, Kevin
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.02.2024
• Subjects: emergency service; fatigue; health personnel; hospital; occupational health; personal protective equipment; fatigue; personal protective equipment; hospital; occupational health; emergency service; health personnel
• ISSN: 1742-6731; 1742-6723; 1742-6723
• DOI: 10.1111/1742-6723.14291

Objective To determine the independent predictors for clinician fatigue and decline in cognitive function following a shift in the ED during early stages of the COVID‐19 pandemic. Methods This was a prospective, quasi‐experimental study conducted in a metropolitan adult tertiary‐referral hospital ED over 20 weeks in 2021. The participants were ED doctors and nurses working clinical shifts in an ED isolation area or high‐risk zone (HRZ) with stringent personal protective equipment (PPE). The participants' objective and subjective fatigue was measured by the Samn–Perelli fatigue score and a psychomotor vigilance ‘smart game’ score, respectively. Postural signs/symptoms and urine specific gravity (SG) were measured as markers of dehydration. Results Sixty‐three participants provided data for 263 shifts. Median (interquartile range) age was 33 (28–38) years, 73% were female. Worsening fatigue score was associated with working afternoon shifts (afternoon vs day, adjusted odds ratio [aOR] 5.16 [95% confidence interval (CI) 1.32–20.02]) and in non‐HRZ locations (HRZ vs non‐HRZ, aOR 0.23 [95% CI 0.06–0.87]). Worsening cognitive function (game score) was associated with new onset postural symptoms (new vs no symptoms, aOR 4.14 [95% CI 1.34–12.51]) and afternoon shifts (afternoon vs day, aOR 3.13 [95% CI 1.16–8.44]). Working in the HRZ was not associated with declining cognitive function. Thirty‐four (37%) of the 92 participants had an end of shift urine SG >1.030. Conclusion Working afternoon shifts was associated with fatigue. There was no association between HRZ allocation and fatigue, but our study was limited by a low COVID workload and fluctuating PPE requirements in the non‐HRZs. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised. The odds of subjects reporting worsening subjective fatigue were five times higher among those that worked afternoon shifts compared to day shifts. Worsening psychomotor vigilance function was associated with new onset postural symptoms and working an afternoon shift. Workplace interventions that target the prevention of fatigue in ED clinicians working afternoon shifts should be prioritised.