ABSTRACT
With fewer staff, and fewer senior staff, in the hospital at night, the level of responsibility shouldered by new doctors on night shifts is categorically different from the daytime. Acutely unwell patients, lower levels of staffing and the profoundly non-physiological demands of shift working mean that the time when most is required of new doctors is also the time when they are cognitively at their most vulnerable. Multiple studies have linked night shift induced fatigue with higher rates of medical error, data made more concerning by the possibility that we may not recognise when we are becoming more hazardous for our patients. Decision fatigue is the phenomenon of serial decision-making leading to a progressive decline in decision quality. On the night shift, reduced doctor to patient ratios produce a particularly high burden of decisions, triggering the use of mental shortcuts, decision avoidance or reversion to the default decision. The chapter considers what can be done to mitigate decision fatigue, before exploring the physiology of night shift working and how understanding this can make us safer working at night. Finally, the chapter emphasises the issue of driving whilst fatigued and the risk to life this poses.
