An assessment of doctors’ perception on the
quality of care received by patients after working
Introduction:
The vision of the TRHA is to be the premier health
provider in Trinidad and Tobago by positively
impacting the health status of the society, through a
dynamic process, in which a strong focus is on
wellness and embraces both domestic and
international clientele. It can be agreed that quality
care is of grave importance (TRHA, n.d.). In recent
times patient satisfaction as it relates to medical care
has been poor.
Though much information is readily accessible on the
patient’s perspective of the quality of care received
from doctors, there is little to no information on the
doctors’ perspective of the care that they give to the
patient after working extended shifts. It is also noted
that for meaningful change to be made in an
organization that the perspectives of all those
involved should be taken into consideration. This
paper focuses on the perception of the house officer.
This is the house officer is usually the doctor who has
the most contact hours with the patient.
The literature provides no definition for extended
working hours as it relates to doctors. It was however
noted that a normal work week for a doctor should
consist of a maximum of six work days. It was also
noted as per the European Union Working Time
Directive 2003, night- workers should work a
maximum of eight hours. Taking the previously
defined and noted into consideration, extended
working hours for this study was defined as working
greater than 16 hours continuously at any given time.
This research aimed to establish the doctor’s
perception on the quality of care they provide for
their patients after working extended shifts. local data
was solicited to facilitate necessary rostering/
scheduling adjustments at the Scarborough General
Hospital (SGH) Tobago, as well as similar organizations
on the island, to ensure that the best care possible is
received by patients.
Method:
• All house officers at the SGH were selected to
participate in the study. A total of 25 questionnaires
was distributed to eligible participants
• A self -administered questionnaire was utilized for this
research.
• The self- administered questionnaires were pre- coded
1-25 to aid in data extraction and were randomly
distributed to each house officer
• The data extracted from questionnaires was analyzed
using the SPSS program version 25. All data was
analyzed for frequency using graphs and charts.
Correlation was then assessed using non-parametric
test.
The University of Trinidad and Tobago Research Symposium August
extended hours.
Dr Jenelle Johnson-Dove
Results:
Frequency of Call
6%
61%
It was noted amongst the departments, that 80% of
respondents of the pediatric department worked 1 in
5 and 20% worked 1 in 4 calls. 66% of respondents in
the obstetrics and gynecology department were noted
to worked 1 in 4 calls whilst 100% of respondents in
the anesthesiology department were noted to work 1
in 4. Though 61% of respondents were noted to have
worked 1 in 4 calls, it was noted that only 5% of
respondents had greater than 2 days off per week
whereas 33% reported having less than one day off
per week and 40% having one day off per week.
With respect to sleep prior to on call shift, it was
reported that 60% of respondents had less than 8
hours sleep whereas 25% had 8-hours sleep and 15%
had greater than 8 hours sleep. 65% of respondents
reported having good quality sleep prior to their call
whereas 20% were noted to have poor sleep quality.
Those reporting very good and very poor sleep quality
were 5% and 10% respectively.
During call, 45% of respondents were noted to have
greater than 120 minutes of sleep whilst 15%
reported having less than 40-minutes sleep.
Bed side Manner after working 8 and > 16 hour shifts
25%
VEY POOR
5%
POOR
20%
10%
GOOD
10%
VERY GOOD
25%
EXCELLENT
0%
5%
0% 10% 20% >16 hours
Discussion:
Working extended hours is noted to have a negative
effect on the quality of care provided to patients
and thus have been regulated by work unions in the
European nations and the United States of America.
It was noted that the effects of extended working
hours may vary with department and it is expected
that with high risk specialties such as surgery and
anesthesiology, that there be an increased level of
fatigue and decreased onset of physician burnout
and its effects on both the physician and the patient
(Tucker , Bejerot, Keckland , & Aronsson, 2013).
It is noted that in our setting, doctors mainly work
extra duty every 4 days (61%), while having one
day or less off per week (40 and 33% respectively).
In this study, 60% of respondents reported having
less than 8 hours sleep prior to call whereas 15%
33%
had greater than 8 hours sleep. It was also noted
1 in 6
1 in 5 that while working extra duty that 45% of
1 in 4
participants slept for greater than 120 minutes
while 15% of participants slept for less than 40-
minutes. As per the recommendation of the
European Union Working Time Directive 2003,
workers should receive a minimum of 20-minutes
sleep for every 6 hours worked. This therefore
implies that the minimum sleep for a 24-hour shift
is 120 minutes.
Working extended hours greater than or equal to
16 hours has proven to a negative effect on the
quality of care provided to patients. This as there is
an increased likelihood of medical errors being
made, poor consenting and counselling as well as
poor bed side manner. Though the risk exists for all
physicians, it is greater in the female population as
well as those that work in high risk area.
Conclusion:
Extended working hours has a negative impact on
the quality of care provided to patients. This can be
improved by decreasing the number of hours
worked daily to no greater than 8 hours. It should
also be noted that adequate time-off should be
given to allow for proper rest and social interaction
to reduce physician burnout and its effects.
Recommendations:
• Decrease the shift time to no greater than 8
hours.
• Allow persons ending shift and starting shift to
work together for one hour to ensure proper
continuity of care. Thus, handovers should begin
at 7 hours of work.
45%
55%
• It should be ensured that time off no less than
24 hours per week is given to ensure adequate
time for rest and social interactions
8 hours
30% 40% 50% 60%
References:
Agency for Healthcare Research and Quality . (2017, June).
Patient Safety Network. Retrieved from Patient Safety Network:
https://psnet.ahrq.gov/primers/primer/19/physician-work-
hours-and-patient-safety
British Medical Association . (2016, 06 30). BMA. (British Medical
Association) Retrieved 09 09, 2017, from British Medical
Association :
https://www.bma.org.uk/advice/employment/working-
hours/ewtd
Brown , M., Tucker, P., Rapport , F., Hutchings , H., Dahlgren , A.,
Davies , G., & Ebden , P. (2010). The Impact of Shift Patterns on
Junior Doctors' Perceptions of fatigue,training, work/life balance
and the role of social support . Quality Health and Safety Care .
10 th th
-17 , 2018