Regular versus extended shift outbreak roster in the emergency department and its impact on staff well-being.

An outbreak response roster during pandemic plays a crucial role, with a recent article1 suggesting a 12-hour extended shift model, aiming to limit interactions between healthcare workers. In Singapore, a typical ED shift is around 8–9 hours. Although there are perceived benefits of working 12-hour shifts like reduction in total number of shifts and compressed working week, it can lead to staff experiencing fatigue, psychological distress, performance reduction and increased risk of errors in a busy, fast-paced ED environment.2 Also, there is a potential risk of cross-exposure as team doctors rotate between managing high-risk and low-risk areas.

Handling a pandemic like COVID-19 can be a marathon, requiring sustainability for a prolonged time period. Roster planning can impact the physical and psychological well-being of healthcare staff. Hence, it was imperative that we develop a roster to prevent cross-exposure among doctors, avoid working long hours and reduce the psychological impact of working longer shifts. Thus, our ED continued to roster staff on usual 8-hour shifts and regular off days, similar to the non-outbreak period. Regular shift durations were more beneficial to the healthcare staff to mitigate fatigue and its associated risks, compared with working longer shifts3 and follow the best practice of safe working hours.

To reduce cross-infection, ED doctors were split into two teams: one team managing the confirmed or suspected COVID-19 patients, while the other managing the non-COVID patients. Considering the fluidity of the pandemic and changing dynamics of patient surge, this roster allows cross-cover from the low-risk to high-risk teams. We rostered standby doctors for both teams, for rapid activation in case of surge or if any staff member was sick, without the risk of interaction between members of different teams.

The type of model to adopt, regular versus extended shift hours, depends on individual ED requirements, based on ED design, pandemic workflows, patient workload and manpower. As the pandemic evolves, we must continually monitor and tweak rostering rules, such that the roster pattern is adapted to best serve our patients and minimise risks of fatigue and burnout of healthcare staff over a prolonged period of time.