The team, based at Great Ormond Street Hospital for Children, set out to redesign the night rota to improve compliance with regulations on working hours, without compromising patient care, medical training, or quality of life of the junior doctors.
They created a new type of senior nurse labelled 'clinical site practitioners' (CSP) with a unique role. Under the new structure CSPs provide leadership, expert clinical advice and management support through a rapid response service to all areas of the hospital, 24 hours a day, seven days a week. The CSP's found that they could manage 70% of calls that traditionally would have been answered by a doctor.
Before the study, night cover was provided through partial shift rotas involving 11 doctors and one senior nurse. Instead, they introduced a full night shift team comprising three middle grade doctors, two senior nurses (CSPs), and a fourth sleeping doctor as back-up for emergencies.
The new rota increased compliance with regulations on working hours from 33% to 77%. Workload changed little and was well within the capacity of the new night team. Most staff were happy with the new rota and the safety of patients was not compromised.
Meeting requirements on junior doctors' hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices, say the authors. They require changes to roles, processes, work practices and attitudes throughout the organisation.
Whilst the authors are committed to achieving safe hours for junior doctors, they also warn that the current inflexible systems for monitoring compliance with targets are putting professionalism at risk.