# Sleep Deprivation and Fatigue in Healthcare Staff: A Clinical Audit on the Risk to Patient Safety

## TL;DR

This study shows that sleep deprivation and fatigue among healthcare workers are common and pose serious risks to patient safety, calling for systemic changes to improve working conditions.

## Contribution

The study provides empirical evidence linking staff fatigue to patient safety incidents in high-acuity clinical settings.

## Key findings

- 38% of staff reported less than six hours of sleep before a shift.
- 100% of staff acknowledged experiencing fatigue-related performance lapses.
- 39% of staff confirmed involvement in or witnessing a fatigue-related clinical error.

## Abstract

Background and objective

Restful sleep is essential, as it helps recharge the entire being. The risk that sleep deprivation and fatigue among healthcare staff pose to patient safety is often overlooked, which can be detrimental to patient safety and outcomes. Prolonged shifts, night duties, and inadequate rest all contribute to fatigue, impair clinical judgment, and increase the likelihood of errors. This research aims to assess the prevalence of sleep deprivation and fatigue among healthcare professionals, examine its association with patient safety incidents, and provide recommendations to mitigate fatigue-related risks in high-acuity clinical settings.

Methods

This cross-sectional, mixed-method study was conducted over three months across three high-turnover hospitals under the same trust. Quantitative data were collected through an anonymous staff survey assessing average sleep duration, frequency of missed breaks, and fatigue-related cognitive symptoms. Qualitative responses were analyzed to identify recurring themes related to fatigue culture and systemic barriers. The study was conducted in high-acuity hospitals within the same UK NHS trust, in three different locations characterized by high patient turnover and complex medical needs. Staff in these settings routinely work long shifts, including overnight duties and back-to-back rotas. Participants included clinical staff working in the selected wards during the three-month data collection period. This included registered nurses, junior doctors, healthcare assistants, and allied health professionals. A total of 102 staff completed the anonymous questionnaire, and 87 participated in structured face-to-face interviews. The primary outcome measure was the proportion of staff reporting less than six hours of sleep before their clinical shift. Secondary outcomes included the frequency of missed or interrupted breaks and self-reported instances of fatigue-related performance issues.

Results

Thirty-eight percent of staff reported sleeping less than six hours before a shift. Forty-four percent indicated they frequently missed protected breaks, and 100% acknowledged experiencing fatigue-related performance lapses. Thirty-nine percent of staff confirmed witnessing or being involved in a fatigue-related clinical error, while 16% chose not to disclose. Qualitative feedback revealed normalization of exhaustion, reluctance to report fatigue, and a lack of institutional emphasis on staff rest and recovery.

Conclusions

This audit revealed a high prevalence of staff fatigue and sleep deprivation, with over half of the respondents reporting insufficient sleep prior to shifts. Missed breaks and fatigue-related cognitive lapses were common, and several clinical incidents were retrospectively linked to staff tiredness. Qualitative data highlighted organizational and cultural contributors, including poor rota planning, underreporting, and normalization of exhaustion. The findings support the urgent need for systemic changes in rota design, rest provision, and fatigue risk recognition as part of broader patient safety strategies.