Hospital at Night: diary of the first night
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7472.s174 (Published 23 October 2004) Cite this as: BMJ 2004;329:s174
Abstract
Reza Jenabzadeh frankly describes his first night on the Hospital at Night scheme
After months of rumours and hearsay the powers that be have finally managed to push the Hospital at Night (H@N)1 project through. Last night was the first night and I had the pleasure of covering surgical patients at the Middlesex site.
“So what's all the fuss about?” I hear you ask. “Nobody likes change!” So why are hospitals all around the land adopting this new method of cover? I think that the answer is simple—the European Working Time Directive.
After one and a half days of “team building” and “training” we were ready. The question is how smoothly would the first night of a new system run? We were all warned that there might be a few “teething” problems. Here is a detailed account of my 2030-0900 shift.
1930
Yes, I know that my shift doesn't start until 2030, but it seems that both the surgical house officer and the specialist registrar (SpR) are not aware of this.
House officer manages to contact me on my mobile informing me that there are four patients that still need clerking for tomorrow's list.
Surgical SpR wants to hand over two patients for me to review as they are being transferred from the UCH (University College Hospital, London) site and he's off at 2000.
2030
Meet in the incident room. This is supposed to be a bleep-free hour for the day staff to hand over to the night staff. Instead we get a rendition of musical bleeps and some day staff arrive late. More positively, we were provided with tea, coffee, and doughnuts. I couldn't help thinking, “Is this to sweeten us up for what lies ahead?”⇓
We were assured that all the menial tasks should be finished by the handover time; however I am given two clerkings and a couple of small jobs.
2130
After a relatively smooth handover the jobs are delegated by our Patient Emergency Response Team (PERT) nurse.
2145
Clerk two preop elective patients. I can't help thinking that this should have been done earlier in the evening.⇓
2245
Surprise, surprise, most of the wards require, fluids, sleeping tabs, antibiotics, warfarin, etc to be prescribed.
2315
It had to happen sooner or later. After an unusually quiet ten minute spell I realise that my bleep is not on my belt clip. I quickly backtrack until I find it.
2330
Given more jobs/reviews by PERT nurse. This doesn't take long so I do a ward round of all the surgical wards, “actively” seeking problems.
A couple of us sneak into the consultants' room to see how the other half live. I spot a comfy chair and know that I will be back later on in the evening for my 20 minute “power nap.”
0100
Meet up in the control room for a one hour “paper round.” We catch up on which jobs remain outstanding and which patients need further reviews overnight.
As there are no further surgical jobs and the medical SHO only has a few jobs the team decide that I should get my power nap. I don't take much persuading. Off to the consultants' room for my 20 minutes!⇓
0430
BLEEP... BLEEP. 20 minutes has turned into two hours. The surgical side had been quiet, but that was all about to change as I am called to deal with an emergency.
Try to contact cardiology SpR who is on another site—this is when the fun and games start. The switchboard on the other site is manned by a porter who doesn't seem to know what he is doing, and more importantly how to get hold of someone who does.
ITU SpR reviews patient and offers advice while we are still trying to get hold of cardiology SpR.
0600
Finally get hold of cardiology SpR, one hour after first picking up the phone.
0700
Patient transferred to coronary care unit. That gives me 30 minutes to get some breakfast and freshen up before our 0730 handover.
0730
Theoretically, all the medical and surgical teams were supposed to send one team member for us to hand back to until 0900. In practice no one turns up and we end up handing over to specific teams over the phone.
Spend the rest of my shift discussing the practical issues encountered overnight.
0900
Home.