A mixed methods study of the impact of consultant overnight working in an English Emergency Department.
Adult
Consultants
/ psychology
Emergency Service, Hospital
/ organization & administration
England
Female
Hospitals, University
/ organization & administration
Humans
Interrupted Time Series Analysis
Interviews as Topic
/ methods
Male
Middle Aged
Personnel Staffing and Scheduling
/ standards
Qualitative Research
Quality Assurance, Health Care
Risk Management
/ statistics & numerical data
Shift Work Schedule
/ adverse effects
Time Factors
efficiency
emergency department
quality
safety
Journal
Emergency medicine journal : EMJ
ISSN: 1472-0213
Titre abrégé: Emerg Med J
Pays: England
ID NLM: 100963089
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
16
02
2018
revised:
03
07
2018
accepted:
28
07
2018
pubmed:
11
8
2018
medline:
26
9
2019
entrez:
11
8
2018
Statut:
ppublish
Résumé
There is a growing expectation that consultant-level doctors should be present within an ED overnight. However, there is a lack of robust evidence substantiating the impact on patient waiting times, safety or the workforce. To evaluate the impact of consultant-level doctors overnight working in ED in a large university hospital. We conducted a controlled interrupted time series analysis to study ED waiting times before and after the introduction of consultant night working. Adverse event reports (AER) were used as a surrogate for patient safety. We conducted interviews with medical and nursing staff to explore attitudes to night work. The reduction seen in average time in department relative to the day, following the introduction of consultant was non-significant (-12 min; 95% CI -28 to 4, p=0.148). Analysis of hourly arrivals and departures indicated that overnight work was inherited from the day. There were three (0.9%) moderate and 0 severe AERs in 1 year. The workforce reported that night working had a negative impact on sleep patterns, performance and well-being and there were mixed views about the benefits of consultant night presence. Additional time off during the day acted as compensation for night work but resulted in reduced contact with ED teams. Our single-site study was unable to demonstrate a clinically important impact of consultant night working on total time patients spend in the department. Our analysis suggests there may be more potential to reduce total time in department during the day, at our study site. Negative impacts on well-being, and likely resistance to consultant night working should not be ignored. Further studies of night working are recommended to substantiate our results.
Sections du résumé
BACKGROUND
BACKGROUND
There is a growing expectation that consultant-level doctors should be present within an ED overnight. However, there is a lack of robust evidence substantiating the impact on patient waiting times, safety or the workforce.
OBJECTIVES
OBJECTIVE
To evaluate the impact of consultant-level doctors overnight working in ED in a large university hospital.
METHODS
METHODS
We conducted a controlled interrupted time series analysis to study ED waiting times before and after the introduction of consultant night working. Adverse event reports (AER) were used as a surrogate for patient safety. We conducted interviews with medical and nursing staff to explore attitudes to night work.
RESULTS
RESULTS
The reduction seen in average time in department relative to the day, following the introduction of consultant was non-significant (-12 min; 95% CI -28 to 4, p=0.148). Analysis of hourly arrivals and departures indicated that overnight work was inherited from the day. There were three (0.9%) moderate and 0 severe AERs in 1 year. The workforce reported that night working had a negative impact on sleep patterns, performance and well-being and there were mixed views about the benefits of consultant night presence. Additional time off during the day acted as compensation for night work but resulted in reduced contact with ED teams.
CONCLUSIONS
CONCLUSIONS
Our single-site study was unable to demonstrate a clinically important impact of consultant night working on total time patients spend in the department. Our analysis suggests there may be more potential to reduce total time in department during the day, at our study site. Negative impacts on well-being, and likely resistance to consultant night working should not be ignored. Further studies of night working are recommended to substantiate our results.
Identifiants
pubmed: 30093377
pii: emermed-2018-207571
doi: 10.1136/emermed-2018-207571
pmc: PMC6580873
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
298-302Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: The authors report that the study was partly funded by the University Hospital studied.
Références
J Emerg Med. 2014 Sep;47(3):372-8
pubmed: 24881892
BMJ. 1999 Jul 17;319(7203):155-8
pubmed: 10406748
Emerg Med J. 2012 May;29(5):366-71
pubmed: 21490371
J Clin Epidemiol. 2015 Aug;68(8):950-6
pubmed: 25890805
J Clin Pharm Ther. 2002 Aug;27(4):299-309
pubmed: 12174032
Emerg Med J. 2013 Oct;30(10):859
pubmed: 24014691
Acad Pediatr. 2013 Nov-Dec;13(6 Suppl):S38-44
pubmed: 24268083
Emerg Med J. 2004 Sep;21(5):575-6
pubmed: 15333534
BMJ. 2017 Apr 4;357:j1678
pubmed: 28377430
Emerg Med J. 2013 May;30(5):360-2
pubmed: 22660466