How should we manage fatigue in on-call workers? A review of guidance materials and a systematic review of the evidence-base

On-call work is known to contribute to disrupted sleep, fatigue, and an increased risk of incidentor injury. This review aimed to a) identify current on-call management strategies that are suggested or required by regulatory bodies, and b) determine if there is empirical evidence to support these strategies in managing the fatigue of on-call workers. A grey literature search produced 65 relevant guidance materials. A systematic inductive thematic process identified consistent strategies included in these materials: 1) regularity/predictability of shifts, 2) fatigue management policy, 3) prescriptive rule sets, 4) fitness for work assessment, 5) on-the-day control measures, 6) risk assessment, 7) training and education, and 8) call management. Subsequently, a systematic review identified 17 original studies on the effectiveness of fatigue management strategies in on-call workers. Very little research has been done on fatigue management strategies for on-call workers outside of some prescriptive hours of work limitations. These limitations generally reduced fatigue, but often had the unintended consequence of increasing workload, which may inadvertently increase overall risk. Training, education, and call management (e.g., protected naps during on-call periods) also had some supporting evidence. The current gap in evidence emphasises the critical need for research on tailored on-call fatigue management strategies.