BMJ Open (Nov 2020)

Need for recovery amongst emergency physicians in the UK and Ireland: a cross-sectional survey

  • ,
  • Jos Latour,
  • Daniel Horner,
  • Laura Cottey,
  • J Leung,
  • Doyo Enki,
  • Blair Graham,
  • Mark David Lyttle,
  • J Browning,
  • F Cantle,
  • J Criddle,
  • J Foot,
  • S Hartshorn,
  • N Mullen,
  • R Hughes,
  • E Williams,
  • S Hall,
  • A Ghosh,
  • M Morrison,
  • S Taylor,
  • DSD Ranasinghe,
  • A Basu,
  • S Gray,
  • E Frost,
  • Tom Roberts,
  • S Lewis,
  • P Fitzpatrick,
  • G Gardner,
  • N Ali,
  • Kara Nicola Stevens,
  • R Bond,
  • J Patel,
  • J Thompson,
  • S Bailey,
  • J Norton,
  • C Thomas,
  • A Paul,
  • K Thomas,
  • H Cooper,
  • L McKechnie,
  • A Knight,
  • E Walton,
  • C Kennedy,
  • L Kane,
  • S Richter,
  • J Selway,
  • C Rimmer,
  • M Ayres,
  • C Ponami,
  • A Quartermain,
  • K Kaur,
  • K McGregor,
  • T Clingo,
  • R Stewart,
  • K Mirza,
  • T Hussan,
  • P Cuthbert,
  • M Alex,
  • F Barham,
  • A Bayston,
  • K Veeramuthu,
  • R Macfarlane,
  • G Lipton,
  • K New,
  • M Jee Poh Hock,
  • E Umana,
  • C Ward,
  • V Agosti,
  • M Connelly,
  • C Weegenaar,
  • J Kerr,
  • SJ Dhutia,
  • T Owens,
  • B Cherian,
  • U Basit,
  • D Hartin,
  • O Williams,
  • C Lindsay,
  • S Manou,
  • MH Elwan,
  • C Nunn,
  • R Fuller,
  • S Stevenson,
  • C Reynard,
  • J Daly,
  • A Da’Costa,
  • L How,
  • G Boggaram,
  • D McConnell,
  • R Hirst,
  • R Campbell,
  • J Muller,
  • H Chatha,
  • R Grimwood,
  • F Fadhlillah,
  • S Ojo,
  • S Ramsundar,
  • A Blackwell,
  • I Traiforos,
  • T Sparkes,
  • L Barrett,
  • M Sheikh,
  • J Driessen,
  • S Meredith,
  • C Newbury,
  • H Grimsmo-Powney,
  • H Malik,
  • L Gwatkin,
  • R Blackburn,
  • F Gillies,
  • TF McLoughlin,
  • SM Rahman,
  • K Hopping,
  • M Broyde,
  • K Challen,
  • M Macdonald,
  • A Randle,
  • E Timony-Nolan,
  • H Fairbairn,
  • G Gracey,
  • K Clayton,
  • C Magee,
  • G Hartshorne,
  • J Foley,
  • S Gardner,
  • S Pintus,
  • K Scott,
  • K Brammer,
  • A Raghunathan,
  • S Langston,
  • S Saunder,
  • C Szekeres,
  • L Kehler,
  • B O’Hare,
  • A Arumugam,
  • C Leech,
  • Y Moulds,
  • DL Thom,
  • A Mackay,
  • R Wright,
  • CE Davies,
  • A Hanks,
  • E Murray,
  • A Saunders,
  • KI Malik,
  • IMV Asif,
  • S Manouchehri,
  • A Fatkin,
  • S Naeem,
  • N Cherian,
  • O Hill,
  • C Boulind,
  • P Williams,
  • S Hardwick,
  • C Gandolfi,
  • E Everitt,
  • G Hampton,
  • D McKeever,
  • D Purdy,
  • L Savage,
  • L Brown,
  • P Harris,
  • R Sharr,
  • R Loffhagen,
  • V Rivers,
  • HD Khan,
  • K Vincent,
  • H Baird,
  • S Bury,
  • E Grocholski,
  • G Kamalatharan,
  • J Gaiawyn,
  • G Johnson,
  • A Tabner,
  • L Abraham,
  • N Sexton,
  • A Akhtar,
  • C de Buitleir,
  • B Clarke,
  • M Colmar,
  • Z Haslam,
  • K Veermuthu,
  • D Raffo,
  • J Stafford,
  • S Mclintock,
  • OR Griffiths,
  • B McIlwham,
  • K Cunningham,
  • E Clegg

DOI
https://doi.org/10.1136/bmjopen-2020-041485
Journal volume & issue
Vol. 10, no. 11

Abstract

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Objectives To determine the need for recovery (NFR) among emergency physicians and to identify demographic and occupational characteristics associated with higher NFR scores.Design Cross-sectional electronic survey.Setting Emergency departments (EDs) (n=112) in the UK and Ireland.Participants Emergency physicians, defined as any registered physician working principally within the ED, responding between June and July 2019.Main outcome measure NFR Scale, an 11-item self-administered questionnaire that assesses how work demands affect intershift recovery.Results The median NFR Score for all 4247 eligible, consented participants with a valid NFR Score was 70.0 (95% CI: 65.5 to 74.5), with an IQR of 45.5–90.0. A linear regression model indicated statistically significant associations between gender, health conditions, type of ED, clinical grade, access to annual and study leave, and time spent working out-of-hours. Groups including male physicians, consultants, general practitioners (GPs) within the ED, those working in paediatric EDs and those with no long-term health condition or disability had a lower NFR Score. After adjusting for these characteristics, the NFR Score increased by 3.7 (95% CI: 0.3 to 7.1) and 6.43 (95% CI: 2.0 to 10.8) for those with difficulty accessing annual and study leave, respectively. Increased percentage of out-of-hours work increased NFR Score almost linearly: 26%–50% out-of-hours work=5.7 (95% CI: 3.1 to 8.4); 51%–75% out-of-hours work=10.3 (95% CI: 7.6 to 13.0); 76%–100% out-of-hours work=14.5 (95% CI: 11.0 to 17.9).Conclusion Higher NFR scores were observed among emergency physicians than reported in any other profession or population to date. While out-of-hours working is unavoidable, the linear relationship observed suggests that any reduction may result in NFR improvement. Evidence-based strategies to improve well-being such as proportional out-of-hours working and improved access to annual and study leave should be carefully considered and implemented where feasible.