Italy: Analysis of anesthesiologists' night shifts

In recent years, several studies have highlighted the risks and challenges associated with hospital night work, attracting increasing scientific attention. Recent international research has broadened this perspective by exploring the burden of anaesthesiologists' perceived night work, with more than 5,000 participants showing negative impacts on professional performance and patient safety¹.

The study we are presenting today² aims to examine in more detail the night working conditions of anaesthesiologists in Italy, taking into account the regulatory peculiarities, the health care system, work characteristics, and resources available in the Italian context.

The researchers conducted a secondary analysis on the data collected from the international survey, focusing on anaesthesiologists working in Italy. The survey included questions on demographic characteristics, scheduling of night shifts, availability of facilities and services during the night shift, and perception of the impact of night work on patients and their quality of life. The analysis was conducted using descriptive statistics to provide an in-depth view of the Italian situation.

The impact of night work on quality of life and patient safety

Of the 1,085 Italian participants, 56% were women, and 76% were aged between 30 and 55 years. The majority worked in public hospitals (92%), 47% of them in academic facilities. The average length of night shifts was 12 hours (76%). The majority of the participants stated that night work negatively influenced their quality of life (77%). Many felt that sleep deprivation significantly influenced their professional performance (67%), and increased the perioperative risk for patients (65%).

The results of this study shed light on a number of critical issues concerning the working conditions of anaesthesiologists in Italy and offer crucial insights for the improvement of professional practices and health personnel management policies. The negative impact of night work, highlighted by 77% of the participants, raises significant questions about the well-being of anaesthesiologists and patient safety.

Working a night shift after working during the day

One of the most worrying aspects that emerged from the study is the practice of working a night shift after a full daytime work shift, a practice that 11% of the participants admit to adopting frequently or always, despite the fact that it is prohibited by law. This phenomenon raises questions about compliance with existing regulations and underlines the need to monitor and regulate working practices more closely in order to ensure patient safety and the well-being of doctors.

Absence of training programmes to manage stress and fatigue

The lack of training and monitoring programmes for stress and fatigue among anaesthesiologists working night shifts in Italy is another critical aspect highlighted by the study. 99% of the participants stated that there are no institutional programmes in their centres to monitor stress or fatigue among night workers. This finding raises significant concerns, as fatigue and stress can impair anaesthesiologists' decision-making abilities and critical thinking, putting patient safety at risk.

The implementation of stress monitoring programmes could help to identify signs of fatigue early, and enable preventive interventions. Lack of training on how to cope with night work may contribute to a negative perception of the experience.

A working environment that needs improvement

The analysis emphasises the need to address the challenges identified through targeted interventions. The lack of facilities and resources during night shifts is another critical issue, highlighting the need for investment in hospital infrastructure to improve working conditions for anaesthesiologists. Doctors, for example, reported that they have rest facilities available during the night shift but are unable to use them afterwards, and that their hospitals do not provide free water or meals during night work.

According to the researchers, these conditions may contribute in part to the shortage of anaesthesiologists that the Italian healthcare system suffers from. It should also be noted that during the night hours, the scarce number of experienced doctors on site may lead to an increase in requests for anaesthesiological consultations to help other specialists in an emergency. This may contribute to stress and increase the risk of burnout.

Targeted interventions are needed to solve critical issues

In conclusion, this study offers an in-depth analysis of the working conditions of anaesthesiologists in Italy and highlights the challenges and critical issues that have emerged. The implementation of targeted interventions is essential to improve the working conditions of night anaesthesiologists while ensuring patient safety.

Investments in hospital infrastructure, training programmes and stress monitoring, together with strict enforcement of current regulations, are all key elements to promote physician well-being and ensure high quality anaesthesiology practice.

Cortegiani A, Ippolito M, Lakbar I, Afshari A, Kranke P, Garcia CSR, Myatra SN, Schultz MJ, Giarratano A, Bilotta F, De Robertis E, Noto A, Einav S. The burden of peri-operative work at night as perceived by anaesthesiologists: An international survey. Eur J Anaesthesiol. 2023 May 1;40(5):326-333. doi: 10.1097/EJA.0000000000001791. Epub 2023 Jan 18. PMID: 36651200.
Galvano AN, Ippolito M, Noto A, Lakbar I, Einav S, Giarratano A, Cortegiani A. Nighttime working as perceived by Italian anesthesiologists: a secondary analysis of an international survey. J Anesth Analg Crit Care. 2023 Sep 11;3(1):32. doi: 10.1186/s44158-023-00119-1. PMID: 37697413; PMCID: PMC10494393.