Decision Fatigue in Out-of-Hours Primary Care
Research type
Research Study
Full title
Decision Fatigue in Out-of-Hours Primary Care: detecting changes in decision making over the work period
IRAS ID
315464
Contact name
Julia Allan
Contact email
Sponsor organisation
ResearchGovernance, University of Aberdeen
Clinicaltrials.gov Identifier
DaSH 510, DaSH reference number; 2-087-22, Sponsor number
Duration of Study in the UK
2 years, 2 months, 1 days
Research summary
Research Summary
Demands on healthcare workers are high: services are stretched, shifts are long, and doctors regularly work lengthy periods without a break. In addition to reducing wellbeing, spending time continuously ‘on task’ changes decision making in predictable ways. Specifically, people make decisions that are progressively easier or more conservative as the period of time worked without a break increases; a phenomenon known as ‘decision fatigue’. In the healthcare context, this could lead health professionals to make different, and sometimes less appropriate treatment and management decisions later in their shifts if adequate breaks are not provided. This shift in decision making can have negative consequences on patients' health outcomes, health professionals' job satisfaction, and lead to unequal access to health care and ineffective allocation of resources. The present project aims to explore decision fatigue in General Practitioners (GPs) and Advanced Nurse Practitioners (ANPs) working in the out-of-hours primary care setting within the Grampian NHS board, two essential professional groups, currently under high, and increasing levels of demand.
This project takes a mixed methods approach where routinely collected out-of-hours consultation data will be used to model changes in GPs’/ANPs’ decisions over time (i.e., we will examine whether there are changes in clinical decision making from the start to the end of shifts; quantitative part A). We will also interview primary care professionals, regularly working within this setting, about their experiences of working for extended periods (qualitative part B). This will help us gather more in-depth information and allow us to find out whether health care professionals are aware of decision fatigue in their context and whether they already utilise any mitigating strategies. By studying when GPs’/ANPs’ decision making starts to change during a work shift, we will be able to estimate how often they should take breaks during periods of continuous work to maintain their clinical judgement at the best possible level.Lay summary of study results
Health professionals make many decisions in a row, often over long shifts without breaks. In two studies, we explored the effects of these long periods of uninterrupted decision-making. In the first study, we analysed routine data from an NHS out-of-hours service to see how clinicians’ documentation practices changed over the course of a shift. We found that as clinicians saw more patients in a row, they recorded less detail in their records about the patients’ history, the diagnosis, and any examinations conducted. They were also increasingly likely to leave some sections blank. This suggests that as workload builds, clinicians shift toward quicker, more concise ways of working and this results in less detailed documentation. In the second study, we interviewed GPs and Advanced Nurse Practitioners about their experiences of working for long periods without a break. Participants were aware that their decision making changed over the course of a shift and reported finding it more difficult to make decisions, making decisions more quickly and feeling less motivated, less confident and less empathetic towards patients as shifts wore on. Factors like being hungry, having a high workload or being time pressured made this worse. Clinicians were aware of changes in their practice over the shift and actively used a range of strategies to maintain optimal decision-making in the face of these challenges. These included taking breaks, sticking to routines, double-checking decisions, seeking advice from colleagues, and adjusting their working patterns where possible. Taken together, these studies suggest that as shifts progress, healthcare professionals experience “decision fatigue,” leading to subtle changes in how they make and document decisions. Clinicians are aware of these effects and actively manage them to maintain high-quality care throughout a shift.
REC name
East of England - Cambridge East Research Ethics Committee
REC reference
22/EE/0259
Date of REC Opinion
17 Oct 2022
REC opinion
Further Information Favourable Opinion