Letters Risks of working time directive

Shorter shifts and more frequent handover

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c4858 (Published 07 September 2010) Cite this as: BMJ 2010;341:c4858
  1. Aditya Manjunath, CT2 urology1,
  2. Shalom J Srirangam, consultant urologist1
  1. 1Royal Blackburn Hospital, Blackburn BB2 3HH
  1. aditya.m{at}doctors.org.uk

    Surgeons claim that the working time directive puts patients’ lives at risk.1 Hospital trusts’ requirement to provide 24 hour acute patient care under the European Working Time Directive and the 48 hour working week has resulted in many junior doctors working more frequent, albeit shorter, on-call shifts, with more handovers between shifts. Such systems reduce continuity of patient care and increase the risk of adverse incidents.

    We investigated the frequency and quality of handover of out of hours urology admissions over two months in 2009. Seventy three patients were admitted between 5 pm and 8 am and were not seen by a middle grade urologist. Twenty patients had their cases handed over orally or in writing, but 53 patients had no handover at all. In only seven of the 20 cases handed over were essential details given and clinical urgency indicated.

    We found that only 27% of out of hours admissions were adequately handed over the following morning. As a result, patients were missed on ward rounds, delaying appropriate treatment and investigation. No critical incidents resulted in long term harm, but several near misses occurred.

    The current reduction in working hours and shift patterns must end to prevent serious consequences to patient care.


    Cite this as: BMJ 2010;341:c4858


    • Competing interests: None declared.


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