Hospital at Night
By Dr Cheryl Koh

Hospital at Night aims to ensure that adequate clinical care is delivered through multidisciplinary teams, using a full shift-working pattern incorporating cross-cover through several disciplines.

Given the time constraints on junior doctors on call or out of hours, we suspect that written data collection may not be as comprehensive as what is collected through a more rapid recording device, such as a dictation machine.

At Rotherham General Hospital, we collected data for our pilot study records on dictation machine. Recordings were transferred to a spreadsheet by a medical secretary and interpreted by a senior house officer and a specialist registrar.

Data was collected over a two-week period from all orthopaedic and general surgical SHOs and registrars. During each shift, five doctors were asked to record each of their tasks. At the end of their shift they handed over their recorders to the next doctor of the same grade who replaced them. Only weekday work between 5pm-8am and out of hours and weekend work was logged.

Clinical reviews were recorded as those events required by a doctor for inpatients. Other tasks were termed technical or clerical. All out-of-hours calls to colleagues - senior and of the same grade - both within and outside respective specialties, were recorded. Most of the work done out of hours was carried out by SHOs and HOs in both specialties. However, registrars were regularly needed for advice, and consultants were required on 14 occasions.

Over the period, 206 new patient referrals were taken, of which 113 were discharged and 96 admitted. A total of 849 clinical reviews and 457 clerical tasks were completed. Thirty-one patients went to theatre and 31 other patients underwent procedures in accident and emergency.

Our study shows that in both general and orthopaedic surgery, senior help needs to be on hand at all times. The volume of work requires the number of doctors working to be maintained at current levels. Some of these tasks could be carried out by non-medical staff with appropriate training and ability.

However, with 849 clinical reviews and 206 new patient referrals in a two-week period, the role of doctors at all grades seems essential.

With the modernisation of medical careers and the subsequent super-specialised training from an early stage, cross-cover between surgical specialties will become increasingly difficult. This may seriously compromise patient care.

Dr Cheryl Koh, Elizabeth Longdon, Kamran Hassan and Manjit Bhamra. whatever you choose must fit with and support your plans in two years’ time.

To read the full research click here

Find out more

The implementation and impact of Hospital at Night pilot projects: An evaluation report
Department of Health, August 2005

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How does a community team or service begin to tackle a long, entrenched waiting list? There is no standard answer Begin by taking some baseline figures for a fairly average recent year, taking seasonal variations into account (it is pointless to wait for a so-called stable period).
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More information

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