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A regional approach to improving night time supervision of accident and emergency departments
  1. P Jaye,
  2. M W Beckett,
  3. A Parfitt
  1. Department of Accident and Emergency, West Middlesex Hospital, Isleworth, UK
  1. Correspondence to:
 Dr A Parfitt
 St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK;

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The objective of this study was to assess the feasibility of senior cover provided to a training region, covering multiple sites, between the hours of 0000 to 0800 by a distant specialist registrar using the facsimile and telephone.

Senior cover is already available to all NHS hospitals within the UK. Unfortunately this is often provided by consultants on unreasonable rotas. Twenty four hour middle grade cover happens rarely. The case mix remains complex and varied however out of normal working hours. North West Thames represents a comparatively compact training region in emergency medicine however staffing levels mean that only two of eight hospitals are able to provide access to a middle grade opinion 24 hours a day. Dale et al1 have shown that what SHOs desire is access to middle grade advice. Senior night time cover is becoming a prerequisite for safe effective supervision of junior doctors practising emergency medicine. Staffing, budget, and recruitment conspire to preclude this dream from reality.

Our hypothesis was that a solitary SpR possibly rotating from the pool within region is able to effectively safely and from a cost viewpoint improve existing services. He was based at one hospital and was available for face to face removed from patient consultation …

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