New Zealand's Christchurch Hospital at night: an audit of medical activity from 2230 to 0800 hours.

ABSTRACT

OBJECTIVE: To audit medical activity at Christchurch Hospital New Zealand between 2230 and 0800 hours; specifically, to measure the volumes of tasks requiring completion overnight and to identify the competencies required for this as well as the level of teamwork that existed. DESIGN: After a pilot study tested possible methods, Resident Medical Officers (RMOs) responsible for the care of adult patients at night were linked by a shift coordinator to recorders (mostly nursing students) trained to register the tasks performed, together with task urgency (as judged by the RMO) and duration. This information, checked each morning for completeness, was entered immediately into a database and analysed later. Telephonists logged all outbound calls through the hospital switchboard to on-call medical staff; theatre and admission records were recorded as usual. Anaesthetic and Radiology Registrar activity was self-recorded. SETTING: Christchurch Hospital is a 650 bed tertiary centre, which covers most specialties. MAIN OUTCOMES: In the absence of leadership, the RMOs were not working as a team. Consequently some were overextended while others were inactive. House officer tasks were largely generic--not specialty specific; there was no formal handover from the afternoon or day shifts and the level of hospital medical staffing did not reflect the activity levels over the time period studied. A review of the beep policy is urgently needed. A third of the admissions were to General Medicine, and basic medical activities (including admitting, reviewing, and prescribing drugs and fluids) for patients admitted under all specialties represented the majority of the night workload. Medical registrars had reduced some of the traditional multiple clerking by admitting patients themselves. The workload and its distribution over time was remarkably similar to that found at the 17 pilot sites in the United Kingdom, where Out of Hours Multidisciplinary Teams (OoHMT) were introduced. CONCLUSION: We recommend that Christchurch Hospital use these data to plan the composition and leadership of an OoHMT.