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Recommendations – stress and fatigue



Decision making is more difficult when staff feel stressed and/or tired. A different perspective improves the chances of making a safe decision.


Clinical staff should be empowered to seek out advice from a colleague not involved in the situation who can give an unbiased perspective (either in person or over the phone).


It must be accepted that calling for help is not a sign of weakness or incompetence, or an inability to cope on one’s own. It is an appropriate response to dealing with a stressful situation. In the case that any healthcare professional needs an unstressed opinion, they must feel able to call a colleague and explain this. An SBAR (Situation, Background, Assessment, Recommendation)[i] handover could help this. “I’m feeling stressed and I’m not sure about this decision, can I check it with you?” Consultants and other senior healthcare professionals, too, are susceptible to stress and units should consider how they can call for help when this situation arises.



When managing a complex or unusual situation involving the transfer of care or multiple specialties, conduct a ‘safety huddle’ – a structured briefing for the leaders of key clinical teams.


This will ensure everyone understands their roles and responsibilities and shares key clinical information relevant to patient safety.


Huddles are both scheduled and ad hoc meetings of key professionals to discuss care and can help to improve communication in complex cases. Safety huddles have great potential benefits to improve staff awareness of safety and communication between staff groups[ii] and are being championed by other specialities such as paediatrics.[iii] They must be short, well led and perceived as useful to staff in order to be successful. They are an integral part of a safety culture, but will only flourish if staff feel empowered to speak openly about patient safety.





[i] Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32(3):167–75.

[ii] Goldenhar LM, Brady PW, Sutcliffe KM, Muething SE. Huddling for high reliability and situation awareness. BMJ Qual Saf 2013;22(11):899–906.

[iii] Royal College of Paediatrics and Child Health: Situational Awareness for Everyone (S.A.F.E) Resource Pack [