Fatigue in focus

In a recent opinion piece in Bloodlines, the magazine for members of the British Blood Transfusion Society (BBTS), Danny Gaskin, a biomedical scientist and Lead Specialist with NHS Blood and Transplant Blood Stocks Management Scheme (BSMS), discussed his concerns regarding out-of-hours working, staff working alone and the effects of fatigue on staff in transfusion laboratories1. After huge member interest, this thought-provoking article was made available, free for everyone to read.  

Danny was prompted to write his article after attending a presentation at SHOT 25 (the annual symposium for the UK’s Serious Hazards of Transfusion [SHOT] haemovigilance scheme) on the impact of fatigue on patient safety. In another presentation, the issue was similarly highlighted when it was shown that more than 80% of transfusion-related incidents reported to SHOT involved preventable errors, with fatigue, night shifts and working alone as significant contributory factors in many of these. Common issues included mismatched blood components, handling errors, and patient identification mistakes. Unfortunately, in a small number of cases, errors have a serious outcome, such as major morbidity or even death. 

Issues are compounded when a sole scientist is covering the work of multiple laboratories in addition to their transfusion responsibilities. Even if the worker is just covering the transfusion laboratory, several highly stressful and time-critical events, such as massive haemorrhages in the emergency department or theatres, can overwhelm them while they still need to manage their existing laboratory workload. 

The obvious question is whether someone working overnight alone and after several nights of consecutive shifts can function safely with judgment potentially impaired by sleep deprivation and a disordered body clock. It is estimated that someone who has been awake for 17 hours has a reaction time equivalent to the legal alcohol limit for driving. Staff fatigue has even been linked to fatal post-shift road accidents. Sleep deprivation is also recognised as causing memory impairment. Unfortunately, the effects of fatigue, which can be cumulative, aren’t always immediately visible. 

In transfusion laboratories, the recognition of harm in SHOT reports has led to SHOT Transfusion Safety Standards, where staff well-being and risks from fatigue must be addressed. Similarly, the UK Transfusion Laboratory Consultative (UKTLC) in collaboration with SHOT [2], provide guidance on laboratory capacity planning to ensure transfusion laboratories can provide a safe and sustainable service. Protective measures such as adequate staffing with the training, skills and experience, along with systems such as IT and communications, which help rather than hinder, are all essential to ensure safe and effective transfusion services.  

So, how do we recognise the effects of staff fatigue and whether we are putting patient safety at risk? This is where close attention to error and adverse event reporting is important, but only if fatigue is identified and noted as a contributory factor, for example, using the SHOT Human Factors Investigation tool. Safety agencies are increasingly taking notice of fatigue and its potential for patient harm.  

Fatigue, of course, is not a problem restricted to staff working in transfusion laboratories, as the risk of fatigue is prevalent across the health system. The UK Health Services Safety Investigations Body’s (HSSIB) report into NHS staff fatigue shows that it is a critical but under-recognised threat to patient safety. Despite the direct or indirect impacts on patient harm it is rarely recorded in incident reports. Also, fatigue is brushed off as a personal issue, not a systemic risk, so it is often overlooked, or not reported, and so organisations fail to learn or improve.  

It is important to acknowledge/recognise that while fatigue is a patient safety issue, the impact on staff wellbeing mustn’t be ignored, and a shift in culture and systems is needed to protect both staff and patients.  

References  

1. BBTS. Fatigue and lone working in transfusion - is it time to scrap lone working in the transfusion laboratory. Instagram. 23 September 2025. Accessed 10 October 2025. https://www.instagram.com/britishbloodtransfusionsociety/p/DO6FDF_jDHu/
2. Dowling K, Davies J, Narayan S, et al. UK Transfusion Laboratory Collaborative: Minimum standards for staff qualifications, training, competency and the use of information technology in hospital transfusion laboratories 2023. Transfusion Medicine. 2024; 34(1): 3-10. doi:10.1111/tme.13029