Condition category
Not Applicable
Date applied
09/09/2019
Date assigned
07/11/2019
Last edited
07/11/2019
Prospective/Retrospective
Retrospectively registered
Overall trial status
Completed
Recruitment status
No longer recruiting

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

Trial website

https://www.rcemlearning.co.uk/foamed/current-projects-tired/

Contact information

Type

Scientific

Primary contact

Dr Laura Cottey

ORCID ID

http://orcid.org/0000-0002-4045-9444

Contact details

Emergency Department
University Hospitals Plymouth NHS Trust
Derriford Road
Plymouth
PL6 8DH
United Kingdom
+44 (0)7470277184
laura.cottey@nhs.net

Additional identifiers

EudraCT number

Nil known

ClinicalTrials.gov number

Nil known

Protocol/serial number

41938

Study information

Scientific title

Trainee-led evaluation of the need for Intershift Recovery among Emergency Department doctors in the United Kingdom

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

Not required. Research limited to involvement of staff as participants (no involvement of patients/service users as participants)

Study design

Observational; Design type: Cross-sectional

Primary study design

Observational

Secondary study design

Randomised controlled trial

Trial setting

Not specified

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet

Condition

Fatigue 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

Phase

Drug names

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 trial start date

01/11/2018

Overall trial end date

10/10/2019

Reason abandoned (if study stopped)

Eligibility

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 type

Patient

Age group

Adult

Gender

Both

Target number of participants

Planned Sample Size: 3500; UK Sample Size: 3500

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

United Kingdom

Trial participating centre

NHS Greater Glasgow and Clyde
J B Russell House Gartnavel Royal Hospital 1055 Great Western Road
Glasgow
G12 0XH
United Kingdom

Trial participating centre

University Hospitals Coventry and Warwickshire NHS Trust
Clifford Bridge Road
Coventry
CV2 2DX
United Kingdom

Trial participating centre

Frimley Health NHS Foundation Trust
Portsmouth Road
Camberley
GU16 7UJ
United Kingdom

Trial participating centre

Cambridge University Hospitals NHS Foundation Trust
Addenbrookes Hospital Hills Road
Cambridge
CB2 0QQ
United Kingdom

Trial participating centre

Croydon Health Services NHS Trust
London Road
Thornton Heath
CR7 7YE
United Kingdom

Trial participating centre

University Hospitals Of Derby And Burton NHS Foundation Trust
Royal Derby Hospital Uttoxeter Road
Derby
DE22 3NE
United Kingdom

Trial participating centre

East Kent Hospitals University NHS Foundation Trust
Kent & Canterbury Hospital Ethelbert Road
Canterbury
CT1 3NG
United Kingdom

Trial participating centre

Medway NHS Foundation Trust
Windmill Road
Gillingham
ME7 5NY
United Kingdom

Trial participating centre

Northumbria Healthcare NHS Foundation Trust
Rake lane
North Shields
NE29 8NH
United Kingdom

Trial participating centre

Royal Liverpool Hospital
Prescot Street
Liverpool
L7 8XP
United Kingdom

Trial participating centre

Aintree University Hospital NHS Foundation Trust
Fazakerley Hospital Lower Lane
Liverpool
L7 9AL
United Kingdom

Trial participating centre

Great Western Hospital
Marlborough Road
Swindon
SN3 6BB
United Kingdom

Trial participating centre

Royal Devon and Exeter NHS Foundation Trust
Barrack Road
Exeter
EX2 5DW
United Kingdom

Trial participating centre

St Helens And Knowsley Hospital Services NHS Trust
Whiston Hospital Warrington Road
Precot
L35 5DR
United Kingdom

Trial participating centre

Northwick Park Hospital
Watford Road
Harrow
HA1 3UJ
United Kingdom

Trial participating centre

Gloucester Royal Hospital
Gloucestershire Hospitals NHS Foundation Trust Great Western Road
Gloucester
GL1 3NN
United Kingdom

Trial participating centre

University Hospital Southampton NHS Foundation Trust
Southampton
SO16 6YD
United Kingdom

Trial participating centre

Southport And Ormskirk Hospital NHS Trust
Southport
PR8 6PN
United Kingdom

Trial participating centre

Imperial College Healthcare NHS Trust
London
W2 1NY
United Kingdom

Trial participating centre

NHS Blackburn With Darwen CCG
Blackburn
BB1 2FD
United Kingdom

Trial participating centre

NHS Fife
Cupar
KY15 5UP
United Kingdom

Trial participating centre

Lewisham And Greenwich NHS Trust
London
SE13 6LH
United Kingdom

Trial participating centre

University Hospitals Plymouth NHS Trust
Plymouth
PL6 8DH
United Kingdom

Trial participating centre

Torbay And South Devon NHS Foundation Trust
Torquay
TQ2 7AA
United Kingdom

Trial participating centre

University Hospitals of Leicester NHS Trust
Leicester
LE1 5WW
United Kingdom

Trial participating centre

Manchester University NHS Foundation Trust
Manchester
M13 9WL
United Kingdom

Trial participating centre

Mid Cheshire Hospitals NHS Foundation Trust
Crewe
CW1 4QJ
United Kingdom

Trial participating centre

Southern Health & Social Care Trust
Craigavon Area Hospital 68 lurgan Road
Portadown
BT63 5QQ
United Kingdom

Trial participating centre

University Hospitals Birmingham NHS Foundation Trust
Birmingham
B15 2TH
United Kingdom

Trial participating centre

Cardiff & Vale University LHB
Cardiff
CF14 4XW
United Kingdom

Trial participating centre

South Eastern Health & Social Care
Dundonald
BT16 1RH
United Kingdom

Trial participating centre

Taunton And Somerset NHS Foundation Trust
Taunton
TA1 5DA
United Kingdom

Trial participating centre

South Tees Hospitals NHS Foundation Trust
Middlesborough
TS4 3BW
United Kingdom

Trial participating centre

University Hospitals Bristol Nhs Foundation Trust
Bristol
BS1 3NU
United Kingdom

Trial participating centre

NHS Lothian
Edinburgh
EH1 3EG
United Kingdom

Trial participating centre

The Newcastle Upon Tyne Hospitals Nhs Foundation Trust
Newcastle
NE7 7DN
United Kingdom

Trial participating centre

Belfast Health & Social Care Trust
Belfast
BT9 7AB
United Kingdom

Trial participating centre

Pennine Acute Hospitals NHS Trust
Manchester
M8 5RB
United Kingdom

Trial participating centre

Guy's And St Thomas' Nhs Foundation Trust
London
SE1 9RT
United Kingdom

Trial participating centre

Portsmouth Hospitals Nhs Trust
Portsmouth
PO6 3LY
United Kingdom

Trial participating centre

Chelsea And Westminster Hospital Nhs Foundation Trust
London
SW10 9NH
United Kingdom

Trial participating centre

St George's University Hospitals Nhs Foundation Trust
London
SW17 0QT
United Kingdom

Trial participating centre

James Paget University Hospitals Nhs Foundation Trust
Great Yarmouth
NR31 6LA
United Kingdom

Trial participating centre

East Suffolk And North Essex Nhs Foundation Trust
Colchester
CO4 5JL
United Kingdom

Trial participating centre

West Hertfordshire Hospitals Nhs Trust
Watford
WD18 0HB
United Kingdom

Trial participating centre

West Suffolk Nhs Foundation Trust
Bury St. Edmunds
IP33 2QZ
United Kingdom

Trial participating centre

NHS Grampian
Aberdeen
AB15 6RE
United Kingdom

Trial participating centre

Homerton University Hospital Nhs Foundation Trust
London
E9 6SR
United Kingdom

Trial participating centre

Airedale Nhs Foundation Trust
Keighley
BD20 6TD
United Kingdom

Trial participating centre

Barts Health Nhs Trust
London
E1 1BB
United Kingdom

Trial participating centre

North Middlesex University Hospital Nhs Trust
London
N18 1QX
United Kingdom

Trial participating centre

Royal Berkshire Nhs Foundation Trust
Reading
RG1 5AN
United Kingdom

Trial participating centre

Lancashire Teaching Hospitals Nhs Foundation Trust
Preston
PR2 9HT
United Kingdom

Trial participating centre

Bedford Hospital Nhs Trust
Bedford
MK42 9DJ
United Kingdom

Trial participating centre

Maidstone And Tunbridge Wells Nhs Trust
Maidstone
ME16 9QQ
United Kingdom

Trial participating centre

East And North Hertfordshire Nhs Trust
Stevenage
SG1 4AB
United Kingdom

Trial participating centre

Lewisham And Greenwich Nhs Trust
London
SE13 6LH
United Kingdom

Trial participating centre

NHS Lanarkshire
Hamilton
ML3 0TA
United Kingdom

Trial participating centre

Leeds Teaching Hospitals Nhs Trust
Leeds
LS9 7TF
United Kingdom

Trial participating centre

York Teaching Hospital Nhs Foundation Trust
York
YO31 8HE
United Kingdom

Trial participating centre

Betsi Cadwaladr University LHB
Bangor
LL57 2PW
United Kingdom

Trial participating centre

Hull And East Yorkshire Hospitals Nhs Trust
Hull
HU3 2JZ
United Kingdom

Trial participating centre

University College London Hospitals Nhs Foundation Trust
London
NW1 2PG
United Kingdom

Trial participating centre

Harrogate And District Nhs Foundation Trust
Harrogate
HG2 7SX
United Kingdom

Trial participating centre

Salford Royal Nhs Foundation Trust
Salford
M6 8HD
United Kingdom

Trial participating centre

Sheffield Teaching Hospitals Nhs Foundation Trust
Sheffield
S5 9AU
United Kingdom

Trial participating centre

Surrey And Sussex Healthcare Nhs Trust
Redhill
RH1 5RH
United Kingdom

Trial participating centre

Western Sussex Hospitals Nhs Foundation Trust
Worthing
BN11 2DH
United Kingdom

Trial participating centre

Aneurin Bevan University LHB
Newport
NP18 3XQ
United Kingdom

Trial participating centre

Hampshire Hospitals Nhs Foundation Trust
Basingstoke
RG24 9NA
United Kingdom

Trial participating centre

University Hospitals Of North Midlands Nhs Trust
Stoke-on-Trent
ST4 6QG
United Kingdom

Trial participating centre

Doncaster And Bassetlaw Teaching Hospitals Nhs Foundation Trust
Doncaster
DN2 5LT
United Kingdom

Trial participating centre

NHS Ayrshire and Arran
Ayr
KA7 1QJ
United Kingdom

Trial participating centre

Warrington and Halton Hospitals Nhs Foundation Trust
Warrington
WA5 1QG
United Kingdom

Trial participating centre

Epsom and St Helier University Hospitals Nhs Trust
Carshalton
SM5 1AA
United Kingdom

Trial participating centre

Bolton Nhs Foundation Trust
Bolton
BL4 0JR
United Kingdom

Trial participating centre

Bradford Teaching Hospitals Nhs Foundation Trust
Bradford
BD9 6RJ
United Kingdom

Trial participating centre

Brighton And Sussex University Hospitals Nhs Trust
Brighton
BN2 5BE
United Kingdom

Trial participating centre

Oxford University Hospitals Nhs Foundation Trust
Oxford
OX3 9DU
United Kingdom

Trial participating centre

Milton Keynes University Hospital Nhs Foundation Trust
Milton Keynes
MK6 5LD
United Kingdom

Trial participating centre

Royal Cornwall Hospitals Nhs Trust
Truro
TR1 3LJ
United Kingdom

Trial participating centre

Shrewsbury and Telford Hospital Nhs Trust
Shrewsbury
SY3 8XQ
United Kingdom

Trial participating centre

Royal Surrey County Hospital Nhs Foundation Trust
Guildford
GU2 7XX
United Kingdom

Trial participating centre

Royal United Hospitals Bath Nhs Foundation Trust
Bath
BA1 3NG
United Kingdom

Trial participating centre

Sheffield Children's Nhs Foundation Trust
Sheffield
S10 2TH
United Kingdom

Trial participating centre

Mid Cheshire Hospitals Nhs Foundation Trust
Crewe
CW1 4QJ
United Kingdom

Trial participating centre

Yeovil District Hospital Nhs Foundation Trust
Yeovil
BA21 4AT
United Kingdom

Trial participating centre

NHS Forth Valley
Stirling
FK8 1DX
United Kingdom

Sponsor information

Organisation

University Hospitals Plymouth NHS Trust

Sponsor details

Derriford Hospital
Derriford Road
Plymouth
PL6 8DH
United Kingdom
+44 (0)1752 431045
crollinson@nhs.net

Sponsor type

Hospital/treatment centre

Website

Funders

Funder type

Research organisation

Funder name

Royal College of Emergency Medicine; Grant Codes: GR222017

Alternative name(s)

Funding Body Type

Funding Body Subtype

Location

Results and Publications

Publication and dissemination plan

Planned publication in a high-impact peer-reviewed journal.

IPD sharing statement:
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.

Intention to publish date

31/12/2019

Participant level data

Available on request

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes

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)