Trainee-led evaluation of the need for intershift recovery among emergency department doctors in the United Kingdom: the TIRED-UK study
| ISRCTN | ISRCTN21869845 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN21869845 |
| Secondary identifying numbers | 41938 |
- Submission date
- 09/09/2019
- Registration date
- 07/11/2019
- Last edited
- 05/11/2020
- Recruitment status
- No longer recruiting
- Overall study status
- Completed
- Condition category
- Other
Plain English Summary
Background and study aims
Emergency departments (ED) provide patient care 24 hours a day all year round. This requires staff to work long consecutive shifts that can result in fatigue. It is recognised that fatigue negatively impacts productivity, exacerbates the risk of human error, and could be associated with occupational burnout. From a patient perspective staff with excess fatigue could led to reduced experience of care and increased patient safety concerns. Fatigue may be measured by a variety of approaches including psychometric testing, assessment of reaction speeds, and personal diaries. However, these methods are impractical for providing rapid assessment within a working population and have limited validity. With rates of burnout as high as 60% in ED doctors there is a need for effective measurements of fatigue in order to produce evidence-based solutions.
The ‘need for recovery’ (NFR) scale is a validated questionnaire originally developed in the Netherlands, to assess how work demands affect inter-shift recovery. It features eleven items requiring a ‘yes’ or ‘no’ response, takes only a few minutes to complete, and shows high acceptability amongst surveyed populations. An online survey using the NFR has been trialled by this research group in a single centre ED and was shown to be an acceptable means of measuring staff fatigue.
This study is a survey aiming to answer the question ‘What is the baseline need for recovery (NFR) score among ED doctors in the UK and which factors influence NFR?’. It will achieve this by conducting a national study to characterise the baseline NFR score in ED doctors across the UK and determine whether there are any associations and differences between NFR scores and demographic, occupational, personal wellbeing, rota characteristics, or geographical region variables. The survey will be open for the period of one month and will take participants approximately 15 minutes to complete.
Who can participate?
Doctors with full or provisional registration with the General Medical Council who have been employed in their main role as an ED doctor for the preceding month at the time of completion of the survey.
What does the study involve?
Participants will complete an online questionnaire
What are the possible benefits and risks of participating?
This study has the potential to aid patient safety by providing individuals and employers with an indication of who is most at risk of increased NFR score, whether disparities exist between different staff groups, departments, and localities, and whether increased need for recovery is a predictor of future occupational burnout.
Where is the study run from?
When is the study starting and how long is it expected to run for?
June 2018 to October 2019
Who is funding the study?
Royal College of Emergency Medicine
Who is the main contact?
Dr Laura Cottey,
laura.cottey@nhs.net
Contact information
Scientific
Emergency Department
University Hospitals Plymouth NHS Trust
Derriford Road
Plymouth
PL6 8DH
United Kingdom
 ORCID ID |
0000-0002-4045-9444 |
|---|---|
| Phone | +44 (0)7470277184 |
| laura.cottey@nhs.net |
Study information
| Study design | Observational; Design type: Cross-sectional |
|---|---|
| Primary study design | Observational |
| Secondary study design | Cross sectional study |
| Study setting(s) | Hospital |
| Study type | Other |
| Participant information sheet | Not available in web format, please use the contact details below to request a patient information sheet |
| Scientific title | Trainee-led evaluation of the need for Intershift Recovery among Emergency Department doctors in the United Kingdom |
| Study acronym | TIRED-UK |
| Study hypothesis | What is the baseline need for recovery (NFR) score among Emergency Department (ED) doctors in the UK and which factors influence NFR? |
| Ethics approval(s) | Not required. Research limited to involvement of staff as participants (no involvement of patients/service users as participants) |
| Condition | Fatigue and recovery in doctors |
| Intervention | This study is being conducted as part of the Trainee Emergency Research Network collaborative (TERN), an initiative by the Royal College of Emergency Medicine to widen access to research by ED doctors and specifically trainees. The methodology for the survey has been designed with regard to the Checklist for Reporting Results of Internet Esurveys (CHERRIES). The design is a cross-sectional online survey with additional ED demographic data collected by a local TERN representative. Each participant will complete the survey once. This design has been chosen for ease of access by participants and has been amended following PPI consultation where proposed questions were reviewed. The 57-item cross sectional survey has been previously trialled during a feasibility study and was found to be acceptable to participants and to have good face validity. The survey will seek to gather information on demographic characteristics (6 items), operational/rota characteristics (25 items), NFR questionnaire (11 items), perceptions relating to burnout (2 items) and one free text item to seek participant’s views on suggestions on recovery. The survey has been designed to minimise respondent fatigue and can be completed in 10-15 minutes using a smart phone app, computer or laptop. In addition to the individual doctor surveys, a nominated TERN representative will collect anonymous site-specific data from EDs which is collected locally and nationally. This methodology has been chosen as previous surveys have found when participants are asked questions which requires them to calculate shift lengths and maximum number of shifts based over a certain period this reduces responses. This data is the same for each group of doctors on a specific rota and therefore can be collected from the roster without burdening participants. The information collected will also include broader information on the characteristics of the ED, staffing, rota pattern, leave allocation, teaching & training, consultant/ senior supervision, case-mix, specialist designation (e.g. Major Trauma Centre, Hyper- acute Stroke centre, etc.) which can then be associated with individuals’ responses. |
| Intervention type | Other |
| Primary outcome measure | Baseline Need for Recovery (NFR) score amongst ED doctors in the UK assessed by NFR questionnaire. |
| Secondary outcome measures | Assessed by 57-item survey: 1. Demographic characteristics 2. Occupational characteristics 3. Well-being characterisitics |
| Overall study start date | 01/11/2018 |
| Overall study end date | 10/10/2019 |
Eligibility
| Participant type(s) | Patient |
|---|---|
| Age group | Adult |
| Sex | Both |
| Target number of participants | Planned Sample Size: 3500; UK Sample Size: 3500 |
| Total final enrolment | 4247 |
| Participant inclusion criteria | 1. Doctors with full or provisional registration with the General Medical Council who have been employed in their main role as an ED doctor for the preceding month at the time of completion of the survey This includes; ED consultants, ED specialist training doctors, ED associate specialist and staff grades doctors, acute common care stem trainees, GP trainees, Foundation Year one and two doctors, clinical fellows and trust grade doctors. |
| Participant exclusion criteria | 1. Doctors whose main place of employment is outside of the ED. This includes speciality doctors employed in specialties other than Emergency Medicine. This will be identified in the demographic questions asked in the survey 2. EDs designated as Type 2, 3, or 4 by NHS England |
| Recruitment start date | 03/06/2019 |
| Recruitment end date | 15/07/2019 |
Locations
Countries of recruitment
- England
- Northern Ireland
- Scotland
- United Kingdom
- Wales
Study participating centres
Gartnavel Royal Hospital
1055 Great Western Road
Glasgow
G12 0XH
United Kingdom
Coventry
CV2 2DX
United Kingdom
Camberley
GU16 7UJ
United Kingdom
Hills Road
Cambridge
CB2 0QQ
United Kingdom
Thornton Heath
CR7 7YE
United Kingdom
Uttoxeter Road
Derby
DE22 3NE
United Kingdom
Ethelbert Road
Canterbury
CT1 3NG
United Kingdom
Gillingham
ME7 5NY
United Kingdom
North Shields
NE29 8NH
United Kingdom
Liverpool
L7 8XP
United Kingdom
Lower Lane
Liverpool
L7 9AL
United Kingdom
Swindon
SN3 6BB
United Kingdom
Exeter
EX2 5DW
United Kingdom
Warrington Road
Precot
L35 5DR
United Kingdom
Harrow
HA1 3UJ
United Kingdom
Great Western Road
Gloucester
GL1 3NN
United Kingdom
SO16 6YD
United Kingdom
PR8 6PN
United Kingdom
W2 1NY
United Kingdom
BB1 2FD
United Kingdom
KY15 5UP
United Kingdom
SE13 6LH
United Kingdom
PL6 8DH
United Kingdom
TQ2 7AA
United Kingdom
LE1 5WW
United Kingdom
M13 9WL
United Kingdom
CW1 4QJ
United Kingdom
68 lurgan Road
Portadown
BT63 5QQ
United Kingdom
B15 2TH
United Kingdom
CF14 4XW
United Kingdom
BT16 1RH
United Kingdom
TA1 5DA
United Kingdom
TS4 3BW
United Kingdom
BS1 3NU
United Kingdom
EH1 3EG
United Kingdom
NE7 7DN
United Kingdom
BT9 7AB
United Kingdom
M8 5RB
United Kingdom
SE1 9RT
United Kingdom
PO6 3LY
United Kingdom
SW10 9NH
United Kingdom
SW17 0QT
United Kingdom
NR31 6LA
United Kingdom
CO4 5JL
United Kingdom
WD18 0HB
United Kingdom
IP33 2QZ
United Kingdom
AB15 6RE
United Kingdom
E9 6SR
United Kingdom
BD20 6TD
United Kingdom
E1 1BB
United Kingdom
N18 1QX
United Kingdom
RG1 5AN
United Kingdom
PR2 9HT
United Kingdom
MK42 9DJ
United Kingdom
ME16 9QQ
United Kingdom
SG1 4AB
United Kingdom
SE13 6LH
United Kingdom
ML3 0TA
United Kingdom
LS9 7TF
United Kingdom
YO31 8HE
United Kingdom
LL57 2PW
United Kingdom
HU3 2JZ
United Kingdom
NW1 2PG
United Kingdom
HG2 7SX
United Kingdom
M6 8HD
United Kingdom
S5 9AU
United Kingdom
RH1 5RH
United Kingdom
BN11 2DH
United Kingdom
NP18 3XQ
United Kingdom
RG24 9NA
United Kingdom
ST4 6QG
United Kingdom
DN2 5LT
United Kingdom
KA7 1QJ
United Kingdom
WA5 1QG
United Kingdom
SM5 1AA
United Kingdom
BL4 0JR
United Kingdom
BD9 6RJ
United Kingdom
BN2 5BE
United Kingdom
OX3 9DU
United Kingdom
MK6 5LD
United Kingdom
TR1 3LJ
United Kingdom
SY3 8XQ
United Kingdom
GU2 7XX
United Kingdom
BA1 3NG
United Kingdom
S10 2TH
United Kingdom
CW1 4QJ
United Kingdom
BA21 4AT
United Kingdom
FK8 1DX
United Kingdom
Sponsor information
Hospital/treatment centre
Derriford Hospital
Derriford Road
Plymouth
PL6 8DH
England
United Kingdom
| Phone | +44 (0)1752 431045 |
|---|---|
| crollinson@nhs.net | |
"ROR" |
https://ror.org/05x3jck08 |
Funders
Funder type
Research organisation
No information available
Results and Publications
| Intention to publish date | 14/10/2020 |
|---|---|
| Individual participant data (IPD) Intention to share | Yes |
| IPD sharing plan summary | Available on request |
| Publication and dissemination plan | Planned publication in a high-impact peer-reviewed journal. |
| IPD sharing plan | The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request from Dr Tom Roberts, TERN@rcem.ac.uk. Anonymised data to both individual and site will be available for one year after the study. This will be available to principal investigators. Others may request the data and such requests will be dealt with on a case by case basis. |
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Protocol file | 20/02/2019 | 07/11/2019 | No | No | |
| Results article | results | 02/11/2020 | 05/11/2020 | Yes | No |
Additional files
- ISRCTN21869845_Protocol_20Feb19.pdf
- uploaded 07/11/2019
Editorial Notes
05/11/2020: Publication reference and total final enrolment number added.
22/09/2020: The following changes were made to the trial record:
1. The trial setting was changed from 'Not specified' to 'Hospitals'
2. The trial type was changed from 'Treatment' to 'Other'
3. The condition was changed from 'Fatigue in doctors' to 'Fatigue and recovery in doctors'
4. The intention to publish date was changed from 31/12/2019 to 14/10/2020.
07/11/2019: The protocol has been uploaded as an additional file.
09/09/2019: Trial’s existence confirmed by National Institute for Health Research (NIHR)
