title: Cognitive and Other Strategies to Mitigate the Effects of Fatigue. Lessons from Staff Physicians Working in Intensive Care Units.
abstract: Fatigue is common among physicians and adversely affects their performance.
  
  
  
  To identify strategies that attending physicians use when fatigued to maintain clinical performance in the intensive care unit (ICU).
  
  
  
  We conducted a qualitative study using focus groups and structured interviews of attending ICU physicians working in academic centers in Canada.
  
  
  
  In three focus group meetings, we engaged a total of 11 physicians to identify strategies used to prevent and cope with fatigue. In the focus groups, 21 cognitive strategies were identified and classified into 9 categories (minimizing number of tasks, using techniques to improve retention of details, using a structured approach to patient care, asking for help, improving opportunities for focusing, planning ahead, double-checking, adjusting expectations, and modulating alertness). In addition, various lifestyle strategies were mentioned as important in preventing fatigue (e.g., protecting sleep before call, adequate exercise, and limiting alcohol). Telephone interviews were then conducted (n = 15 physicians) with another group of intensivists. Structured questions were asked about the strategies identified in the focus groups that were most useful during ICU activities. In the interviews, the most useful and frequently used strategies were prioritizing tasks that need to be done immediately and postponing tasks that can wait, working systematically, using a structured approach, and avoiding distractions.
  
  
  
  ICU physicians reported using a variety of deliberate cognitive and lifestyle strategies to prevent and cope with fatigue. Given the low cost and intuitive nature of the majority of these strategies, further investigations should be done to better characterize their effectiveness in improving performance.
authors.affiliation: 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Henrich
authors.affiliation: 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.|2 Division of Critical Care Medicine, Department of Medicine.|3 Sleep Disorders Program, University of British Columbia, Vancouver, British Columbia, Canada; and.
authors.forename: Najib T
authors.initials: NT
authors.lastname: Ayas
authors.affiliation: 4 Department of Critical Care Medicine and.|5 Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
authors.affiliation: 1 Centre for Health Evaluation & Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.|2 Division of Critical Care Medicine, Department of Medicine.|6 Centre for Health Education Scholarship, and.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Peets
mesh_terms: D000046:Academic Medical Centers; D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D002170:Canada; D003071:Cognition; D003422:Critical Care / Q000379:methods; D015444:Exercise; D005221:Fatigue / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D000070497:Healthy Lifestyle; D006801:Humans; D007362:Intensive Care Units; D007407:Interviews as Topic; D008297:Male; D010820:Physicians / Q000523:psychology*; D036301:Qualitative Research; D012890:Sleep; D000078329:Workforce
keywords: cognitive reserve; critical care; fatigue; qualitative research; sleep deprivation