Hospitals are being urged to make greater use of the skills of nurses and other non-medical staff out of hours, following research which showed new staffing models could improve patient care and bring junior doctors’ hours down to safe levels. The findings are published in the NHS Modernisation Agency report ‘Findings and Recommendations from the Hospital at Night project’.It shows that current staffing levels fail to reflect the marked drop in hospital activity levels after midnight. The Hospital at Night project is a collaboration between the Department of Health, the BMA, and other professional bodies. Its aim is to improve efficiency and to challenge traditional thinking about the staff needed to provide care out of hours. Its work has been given added importance because of the European Working Time Directive, which will introduce a maximum 58-hour working week for junior doctors from August this year.
The project began by investigating the nature of junior doctors’ work out of hours with an audit of 20,000 clinical incidents across 11 hospital trusts over a two-week period last year. This showed that the doctors spent much of their time on tasks that had already been performed by another doctor, or that could be performed by a nurse, porter, or other healthcare professional. It found that junior doctors’ workloads could be cut by up to a half by reducing the time they spent on unnecessary tasks.
The research also showed there was a large drop in hospital activity levels at night with the number of calls to doctors at five in the morning running at a quarter of the number at five in the evening. The audit found that a significant proportion of nighttime work was non-urgent and could be brought into the day and that in some specialties, such as orthopaedics, very few calls were made to junior doctors at night.
Based on the findings of the audit, the project team piloted new ways of working at four NHS trusts – Royal Liverpool and Broadgreen, Wirral Hospital, Homerton University Hospital, and Morecambe Bay. The trusts used single multidisciplinary teams made up of consultants, junior doctors, nurses, and others at night rather than having junior doctors from each specialism on call.
The interim report from the project is recommending that hospitals use local data to re-assess thinking about staff needs to out of hours, improve the way evening work is managed and resourced to reduce night-time workload and improve the way information is passed between staff to reduce the number of clinical incidents at night.