Objectives & Background EM and Paediatrics are specialties at the forefront of the move towards 24/7 consultant delivered care. This shift has been partly driven in EM by trauma pathways, as well as aiming to provide better patient care, and to support training.
Chelsea and Westminster Paediatric ED sees around 34,000 children a year. It is not a major trauma centre. In May 2013, 6 consultant paediatricians were appointed to be resident in PED at night. This study evaluates the PED team's perceptions of the impact of this change on the quality of clinical care, training and job satisfaction, and of trainee's views of undertaking a similar role in the future.
Methods An online questionnaire was sent to all nursing staff and junior doctors (ST1-ST8) working in PED, in May 2014. Questions were answered on a 5 point Likert scale, with scope for free text responses, and role specific questions for both nursing and medical staff.
Results 26/35 (75%) of staff responded (42% medical/58% nursing staff). 72% of respondents preferred working with resident consultants.
Clinical Care 100% of trainees and 80% of nurses felt the quality of care was improved at night. 90% felt it improved the management of a resuscitation, and 100% felt it was easier to discuss safeguarding concerns.
Training & Supervision Trainees felt it improved their supervision in practical procedures (70%), increased their opportunity to complete WBPAs (80%), and increased the number of learning opportunities (70%). Registrars were concerned that opportunities for leadership and management experience were reduced.
Nursing staff 87% believed decision making was faster, 73% felt children spent less time in the department and 80% felt waiting times were reduced.
Perceptions Only 30% of trainees would like to work as a resident consultant in the future. 90% believed that resident on call working should be time limited.
Conclusion PED staff at C&W have welcomed the move to 24/7 consultant delivered care. The core aims – to improve the efficiency and proficiency of patient care, and to better utilise out of hours working as a training opportunity – are being achieved. Concerns remain about disempowerment of senior trainees and the perceived impact of night shifts in a consultant role on work-life balance. To sustain this model, trainees must be convinced of the benefits of becoming a resident consultant upon their own career.
- emergency care systems
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