Work related fatigue and sleepiness at work among intern house officers of four hospitals in Sri Lanka

Introduction: Intern house officers (IHOs) are expected to work long duration shifts with frequent on-calls. Lack of adequate sleep due to prolonged duty hours leads to increase in medical errors. United States and European countries have imposed guidelines to restrict duty hours of IHOs, however no such restrictions are implemented in Sri Lanka.

Objectives: The aim of this study was to evaluate fatigability and sleepiness at work among IHOs of four main hospitals in Sri Lanka.

Method: IHOs of Colombo South Teaching Hospital, National Hospital Sri Lanka, Lady Ridgway Children’s Hospital and De Soysa Maternity Hospital were recruited. Duty rosters were analysed for the length of duty shifts and night on-calls. Questionnaires were used to record fatiguability, sleepiness at work, medical errors, risk at work and daytime sleepiness.

Results: Out of 94 IHOs, 73% worked more than 100 hours and 32% worked more than 125 hours a week. Notably, 38% did three night on-calls per week and 31% did more than three. Subjective fatigue level at work was reported as “most of the time” and “always” by more than 80% of IHOs, 32% had severe day time sleepiness. Fatigue risk assessment score indicated that 97% IHOs were in the high-risk group. Female IHOs were found to be more fatigued. One third of doctors reported medical errors due to fatigue and sleepiness which was significantly high in medicine rotation.

Conclusions: IHOs were found to be over working. Majority were fatigued and sleepy at work. Self reported medical errors during internship were found to be high.