For patients admitted to hospital at night or on a weekend, the statistics make for uncomfortable reading.
Two things tend to happen at these times: fewer clinicians are available to care for patients and those who remain are further from the support provided by senior colleagues. Doctors on out-of-hours shifts work in stressful environments often performing complex tasks which are difficult to prioritise. They are often required to navigate large and unfamiliar sites to find wards, patients, other staff and equipment – all of which affect time spent on frontline care.
And yet the issue of out-of-hours care has been poorly documented over the years, despite the negative impact it has on patients, on staff stress levels, its links to absenteeism and increased costs for the NHS.
But that is now changing, thanks to the WayWard project. Led by researchers at Nottingham’s Horizon Digital Economy Research Centre, WayWard is using the latest tracking technology to shed new light on the way that out-of-hours care is delivered and managed. Alongside interviews, observations and data from task management systems employed by hospitals, WayWard uses new geospatial technologies developed at Horizon – such as positioning and tracking boxes worn by participating staff – to build up a better picture of out-of-hours work.
The findings have helped to inform a new Safe Staffing report, published in 2018 by the Royal College of Physicians (RCP).
Dr James Pinchin, Transitional Assistant Professor at Horizon and co-investigator on WayWard, is an expert in measuring human behaviour with positioning technology. He said: “If you want to know how to staff wards properly, you need to know how much work they will be expected to take on.
By providing junior doctors with successful management strategies developed by experienced staff, we aim to make their early shifts less stressful – and ultimately safer for patients
"For the RCP report we developed a mathematical method to measure the location of the doctors and combined that knowledge with task logs to estimate the most likely ordering and timing of the tasks they completed.
"Our findings showed that task versus demand on doctors working out-of-hours is predictable, measurable and increasing. Most of the work being dealt with by out-of-hours doctors consists of ‘legacy’ tasks left over from under-resourced day shifts. Sometimes this is necessary, due to drug scheduling, for example, but much of the time it isn’t.”
The RCP report will help NHS trusts understand how many staff they need to care for patients safely. It estimates the number of hours that clinicians need to be present in a given situation and the examples of staff needed to work these hours.
The study tracked doctors at Nottingham University Hospital’s QMC and City Hospital sites, along with Aintree Hospital in Liverpool. The Nottingham sites in particular are extremely large and complex environments – QMC is one of the largest teaching hospitals in Europe, while City has around 11,000 doors – which can lead to a great deal of time and energy lost as doctors go from one call to another.
Dr Sarah Martindale, part of the WayWard research team, said: “The RCP report is a first attempt to indicate how many medical clinicians are needed in the out-of-hours system. This will be refined, validated and iterated but the hope is that in the future mandated staffing levels will deliver safer care and allow more careful use of staff through the type of evidence we provided."
By studying where doctors carry out tasks and how they prioritise conflicting demands, WayWard is helping to inform rota design to make shifts less stressful and safer for patients. It is also contributing insights from real shifts into the training of junior doctors about to embark on out-of-hours shifts.
“By providing junior doctors with successful management strategies developed by experienced staff, we aim to make their early shifts less stressful – and ultimately safer for patients”, Dr Martindale added.