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The negative effectation of shift working is an issue that affects a lot of the doctors and may have its influence on patient's safety. Hence, it is necessary to style a good Rota system that would help to supply 24/7 service cover, minimize risks to staff (doctors) and patients and enhances the effectiveness of delivery of service.

Various studies have given evidence that shift working may have multiple short-term and long-term effects on doctors. A Japanese study in a university hospital suggested that continuous practice and large number of patients has correlation with increased medical errors. Temporary effects may include fatigue, needle stick injuries, irritable bowel syndrome, post shift accidents (RTA). Long term effects would include the increased incidences of cardiovascular diseases, myocardial infarction, stroke, sleep deprivation and neurological disorders. The consequences of long shifts are not only felt on health but in addition on the private relationships.

A survey was performed on peril-operative deaths by UK CEPOD that linked the medical errors with fatigue and sleeps deprivation. Furthermore, it also identified risks in relation to the amount of shifts worked. Reported adverse incidents risen up to 6 per cent on second night shifts, 17 per cent on third and 36 per cent on fourth night shift worked. The price incurred by this negligence is also very high.

The important thing to minimize the risks is to style good Rota system to avoid excessive out of hours doing work for doctors on the Rota. Providing good working conditions and facilities to rest during shifts may also help to enhance the performance. On-call rooms should be around for night-working staff and be of sufficient standard to facilitate adequate rest breaks and for post-call resting. Furthermore, a Fatigue Risk Management System must be set-up in hospitals which will ensure care and support to the doctors and other medical staff.

The support of hospital management, Rota masters and senior doctors is needed and all of them may have their very own views on this. Effective working of Rota System may be difficult during medical emergencies, epidemics (Swine Flu) and natural calamities like earthquake, floods, etc. because of large no. of patients. Doctors and other medical staff will have to re-juggle their fixed schedules. Doctors should be more flexible using their working patterns. Patients could have problems and would not be comfortable with other doctors during a specific shift. ("I wish to see my doctor.")

Need: Increasing demand in hospital practice has generated 24 hours service delivery. Shift structure predisposed to intensive work load and can therefore lead to fatigue and decreased performance. Good rota design can mitigate the likelihood of fatigue developing. Customer Service could be enhanced and improved, removing the gaps within it.

Customers: Doctors, Local Patients, Visiting Patients, and other medical staff.

Costs: The NHS Litigation Authority in England paid £769m in reference to clinical negligence claims in 2008/09 compared with £633m in 2007/08. To cut back such costs. To be affordable giving value for money. The overall costs incurred in creating the policy will soon be much significantly less than the price expenditure to cover the clinical negligence claims.

Competition: Private practitioners, traditional healers, etc. Medical workers that do not need fixed working shifts and are flexible.

Sufficient evidence is currently present which concludes that shift work particularly out-of-hours shift work is harmful for doctors; even in short term and may have negative effect on the patient's safety. As a consequence, several recommendations may be made: shift lengths must be as short as practicable, rest breaks must be facilitated and doctors encouraged to rest during night shifts around is possible; and shift workers and employers have to be educated as to how circadian rhythms may be altered, and thus maximize alertness at the office, to minimize risks to staff, to patients and to society as a whole.

Good Rota design that delivers 24/7 service cover, optimize training opportunities and that minimizes the adverse effects must be adopted. Proposition to style a good Rota system employing a constructive approach, to minimize the harmful aftereffects of long shifts and reduce medical errors. Rota System design that could be, 4 - 8hrs day shifts, followed closely by 1-7hrs night shift and then 2 days rest period. The doctor's shifts are arranged accordingly in order to give 24 hr services. Avoiding shifts of more than 12 hrs. A normal 24 hr on-call Rota model must be adopted for a few specialties.

The support of hospital management, Rota masters and senior doctors will soon be essential and accepted by everyone within the system. Encouraging accurate and honest monitoring of rotes. Monitoring of the effectiveness can be achieved by using charts and line diagrams to assess its working. Feedback from doctors, management and patients is necessary. This improvement should be produced available the moment possible and must be immediately placed into practice.


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