Paediatric units should move towards resident on-call shifts for consultantsBMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3202 (Published 04 May 2012) Cite this as: BMJ 2012;344:e3202
Paediatric units should always have a consultant present in the hospital outside normal working hours, to improve quality of patients’ care around the clock, the Royal College of Paediatrics and Child Health has recommended.
This model of consultant delivered care will also ensure good handovers and improve communication with patients and their families, the college adds, and will help hospitals deal with rota vacancies, reduce costs of locums, and ensure compliance with the European Working Time Directive.
“Patients deserve to be treated with the same high standard of care whatever time of day or night they are admitted to hospital, whether that be at 11 am on Tuesday morning or 10 pm on Sunday evening,” said Carol Ewing, workforce planning officer at the college. “We should always look at ways to improve our hospital services, and I believe that by rolling out a model of consultant delivered care—or tailoring a variation of the model to a service’s busiest day or time of the week—our NHS will be a much better service.”
The Royal College of Paediatrics and Child Health has completed a six month project with 139 (63%) of the 222 paediatric inpatient and neonatal trusts in the United Kingdom to establish current approaches to consultant delivered care and the benefits of these models for patients and doctors.
Acute paediatric patients require face to face consultant care up to 24 hours a day because symptoms can progress rapidly and illnesses can increase in severity in a short period of time, the college says in its report.
In a consultant delivered service the consultant is clinically responsible for the care the patient receives and will either provide hands-on care or closely supervise all aspects of the care. This model requires a consultant to be present in the hospital outside normal working hours as a “resident shift working consultant.”
The college’s research found that nearly all (96%) of the 139 units included in the survey used some form of consultant delivered care, and a similar proportion (90%) had at least one consultant led handover each day.
Fourteen of the 17 consultants working resident shift patterns who were interviewed by the college agreed that consultant delivered care was a good service model, citing beneficial effects on decision making, reduced admissions, and good teaching and training on the job.
The college does question whether all consultants, regardless of age, should work resident shifts throughout their career but suggests use of a sliding scale of on-call commitment inversely proportional to the consultant’s experience to reduce the intensity of on-call work for older consultants.
The research also suggests that consultant delivered care can improve the quality of training for junior doctors. Four fifths (83%) of trainees interviewed thought that their teaching was good or excellent in consultant delivered care models, and most indicated that the model has improved training. However, some trainees suggested that consultant delivered care may disempower trainees because consultants will be making all the clinical decisions.
The Royal College of Paediatrics and Child Health has said that other 24/7 specialties that do not use cross cover to provide out of hours services—such as obstetrics and gynaecology, anaesthetics, and emergency medicine—could also benefit from implementing consultant delivered care.
Consultant Delivered Care: An Evaluation of New Ways of Working in Paediatrics is available at www.rcpch.ac.uk/cdc.