Thursday, 2 December 2010

Patients get worse care out of hours due to staff shortages, report claims

Patients being admitted to hospitals outside office hours and at weekends receive poorer care due to a lack of consultants, the Royal College of Physicians has warned.

An audit conducted by the College has found that many hospitals do not have senior specialist doctors looking after patients admitted with serious illnesses outside normal working hours.

Consultants are already working 50 hours a week, more than they are contracted for, so the solution can only be to increase their numbers and work their rotas more effectively, the report said.

Studies by the College have already found that junior doctors look after an average of 61 patients in hospital overnight and one doctor was looking after 400 people.

Others have found babies born outside working hours are 70 per cent more likely to die and patients attending A&E departments at the weekend have higher death rates.

The College is asking for an urgent meeting with Andrew Lansley, Health Secretary, to discuss the problem.

Sir Richard Thompson, president of the Royal College of Physicians said: “Despite major improvements in the care of acutely ill patients which were led by the RCP following our major report in 2007, patients are still not getting the care they deserve at night and at weekends. “Too many junior doctors are covering too many very ill patients, and this has to change.

“Our evidence shows that a predominantly consultant-delivered medical service is the best way to improve patient care.”

A representative survey of 126 hospitals from around the country examined working patterns and patient care in acute admissions units, which are used to care for patients who need to be admitted urgently either from A&E or who have been sent by their GP.

Few hospitals had sufficient cover from consultants specialising in acute medicine staffing these units round the clock.

The report found:

– Almost three quarters of acute physicians do not work at weekends and only two thirds contribute to the on-call rota.

– All patients are not routinely seen by a consultant twice per day throughout the seven day week.

– Almost half of hospitals do not have the recommended three consultants specialising in acute medicine.

– In just under half of hospitals the on-call consultant has other routine clinics and tasks to complete while on call and do not cancel them in line with recommendations.

– Many patients are only seen once per day in a formal ward round in the acute phase of their illness.

– A small number of units appear to a have poor monitoring or staffing facilities to manage acutely unwell medical patients.

– In three quarters of the acute medical admissions units accepting patients directly from GPs, the unit runs out of beds.

– Nearly three-quarters of hospitals in the survey had no cover from consultant physicians specialising in acute medicine over the weekend.

Dr Jonathan Potter, Clinical Director of the RCP’s Clinical Effectiveness and Evaluation Unit, said: “Despite improvements in facilities and staffing, hospitals still need to address working arrangements to ensure that senior doctors are readily available to provide a consultant led service in acute medical admissions units seven days a week.”

Secretary of State for Health, Andrew Lansley said: "Sir Richard Thompson is right, patients do deserve better care at night and weekends and senior doctors should be available to provide acute medical care as needed.

“I have already asked Medical Education England to consider with the profession, the service and medical Royal Colleges, how best to secure better patient outcomes and the right level of supervision for trainees through greater consultant involvement in direct clinical care at night and at weekends."

Source : Telegraph

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