Fatigue Risk Management
Fatigue Risk Management FRM supports safe clinical learning and high quality patient care by reducing fatigue related risk. Fatigue is an occupational risk in residency training. When unrecognized or unmanaged, it can impair judgment, communication, and performance. FRM addresses fatigue at a systems level, not as an individual weakness, but as a shared responsibility for safety.
Why Fatigue Matters
Evidence demonstrates that:
• Fewer than five hours of sleep within twenty-four hours increases the likelihood of impaired task performance
• Fatigue related impairment risk is greatest between 0200am and 0600am, increases during the mid afternoon circadian dip, and rises markedly after sixteen hours of sustained wakefulness, with implications for clinical judgment, vigilance, and patient safety
• Twenty-four hours of sustained wakefulness may impair cognitive function to a degree comparable to being over the legal driving limit
• Chronic fatigue contributes to emotional exhaustion, stress, and burnout
• Fatigue is associated with increased risk of motor vehicle accidents
Fatigue affects patient safety, physician wellbeing, and team performance.
Clinical Impairment and Professional Responsibility
Drug or alcohol impairment is not permitted in the clinical environment. Fatigue related cognitive impairment warrants the same level of attention and response.
Impairment, regardless of cause, is a patient safety issue. Recognizing and addressing fatigue is a professional responsibility shared by individuals, programs, and the institution.
Our Approach
FRM at Dalhousie includes:
1. Education on sleep science and recognition of fatigue
2. Safe scheduling principles
3. Confidential and non punitive reporting pathways
4. Clear communication and escalation practices
5. Ongoing quality improvement review
Fatigue related events are often indicators of system vulnerabilities rather than individual failure.
What To Do If You Are Too Fatigued To Be Safe
1. Inform your supervisor.
2. Transfer or pause high risk tasks when appropriate.
3. Use the internal reporting and escalation pathway.
4. Access available recovery and support resources.
Immediate patient safety concerns should follow standard patient safety reporting procedures.
Guidelines
The full Fatigue Risk Management guidelines, including definitions, roles, procedures, and accreditation alignment, is available here:
Contact
For questions regarding Fatigue Risk Management:
Jenny Acuna jenny.acuna@dal.ca