Project Title:

Optimising digital health tools for sleep and fatigue management in NHS shift workers: potential impact on patient, staff, and organisational outcomes.

Type of Research:

Survey, qualitative

Background & Scientific Rationale:

Front-line ambulance sector staff are at elevated risk of depression, post-traumatic stress disorder, weight gain, and poorer cardiometabolic health (1), with poor sleep quality having been implicated in all of these outcomes. Our current review highlights the paucity of research on the wellbeing of ambulance sector personnel in the UK, with no peer-reviewed intervention studies and only two on sleep/fatigue, as secondary outcomes (2). International evidence has shown that 70% of paramedics may experience at least one sleep-related problem (3), and poor sleep quality is likely to have direct and indirect associations with a range of adverse patient, staff, and organisational outcomes, including patient care quality and safety, staff mental health and burnout, absenteeism, and turnover (4-6). Shift work is an inevitable part of health
care, and employers have a responsibility to minimize organisational risks to staff wellbeing and to promote opportunities for self-care amongst staff.

Research aims:

At one NHS Ambulance Trust (East of England Ambulance Service NHS Trust, EEAST), we aim to:

  1. Estimate the prevalence of poor sleep quality and fatigue while at work, the perceived impact on clinical performance and patient-related outcomes, the actions staff take to help with sleep and fatigue at work, and the acceptability of digital tools for self-management.
  2. Explore initial acceptability of, barriers to use, and preference (if any) for two digital tools for sleep and fatigue management, and potential impact on clinical care and patient outcomes.


Our proposal will explore the applicability and potential outcomes of two
digital interventions that have shown promise but have not yet been tested in the UK ambulance setting: a text messaging intervention to manage fatigue at work,  developed for US paramedics but not yet tested in any other country; and a digital cognitive behavioural therapy (CBT) intervention for poor sleep and insomnia that is NICE-recommended but not yet tested amongst NHS or shift workers (Sleepio). We will conduct a quantitative online survey with follow-up qualitative interviews. .

Expected Output of Research / Impact and added value:

We will publish the first prevalence estimates of sleep and fatigue problems in ambulance personnel, and perceptions of how it impacts clinical and patient-related outcomes. Through ALF these findings will inform all ambulance services in the UK, with implications for how Trusts manage staff fatigue and sleepiness both through selfmanagement and shift scheduling, and by identifying which quality and safety outcomes are most sensitive to staff fatigue. This is particularly relevant to EEAST given the proposed changes in shift length and start/finish times as part of the 6-year funding deal with CCGs, NHS England and NHS Improvement.


For further information on this project, please contact Kristy Sanderson


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