Fatigue, recovery and work engagement among post-call doctors at tertiary public hospitals in Selangor : the predictive roles of on-call and intershift factors

Abstract

Post-call fatigue amongst doctors is a growing concern in Malaysia. However, fatigue and its recovery amongst post-call doctors in Malaysia have not been empirically established. Therefore, this study aims to determine the role of on-call factors (on-call demand, on-call duration) and intershift factors (home-to-work transition, recovery experiences, intershift duration) in predicting post-call fatigue and its recovery at post intershift. Furthermore, this study is also conducted to determine the relationship between post-intershift fatigue with work engagement at the beginning of the next shift. This is a multicenter longitudinal day-level two-wave panel study by using self administered questionnaires amongst 390 randomly sampled post-call medical officers from seven core clinical disciplines working at seven tertiary public hospitals in Selangor. Data was analyzed by using descriptive, bivariable and covariance-based structural equation modelling analysis. The response rate was 91.8% (n=358). Their mean on-call and intershift duration were 26.8 (SD=4.03) and 19.0 (SD=4.10) hours respectively. Post-call doctors with long on-call duration (≥ mean i.e. ≥27 hours) have significantly higher post-call fatigue level. However, there is no significant difference in post-intershift fatigue between those with long (≥ mean i.e. ≥19 hours) and short (< mean i.e. <19 hours) intershift duration. Overall, there was a significant reduction in the mean level of fatigue from post-call to post-intershift by 2.90 (95%CI=2.66, 3.15; p<0.001). We found that on-call demand (β=0.464, p<0.001) and on-call duration (β=0.106, p<0.05) directly predicted the post-call fatigue. Subsequently, the post-call fatigue directly predicted post-intershift fatigue (β=0.357, p<0.001). This relationship was partially moderated by intershift duration whereby those with short intershift duration <19 hours strengthen the relationship between post-call fatigue and post intershift fatigue. This relationship was also partially mediated by recovery experiences (indirect effect: β=0.048, p<0.05), but not mediated by home-to-work transition. However, home-to-work transition, which was directly predicted by on-call demand (β=0.200, p<0.05), indirectly predicted the post-intershift fatigue through recovery experiences as mediator (β=0.121, p<0.001). Finally, the post-intershift fatigue was directly related to work engagement (β=-0.554, p<0.001). In conclusion, both on-call and intershift factors predicted the post-call fatigue, its recovery at post intershift, and the next-shift work engagement, which generally support the conservation of resources theory. Policy makers should consider these findings as part of evidence-based information to improve current policy in addressing the issue of post-call fatigue and its recovery among doctors.