Background In August 2009 junior doctors hours will reduce to 48 hours per week averaged out over 17 weeks. RLC are currently a National Workforce Projects Working Time Directive (WTD) Pilot site, aiming to develop solutions that would achieve compliance within paediatrics. Recognising that no one solution will address WTD, the project consists of a number of initiatives.

Method A Rapid Improvement Structured and Targeted approach was utilised. Existing team structure, number of posts at each level, requirements for on-call were reviewed. Consideration was given to cross cover or on-call from home out of hours. Rota-planning technology was used to develop compliant rotas.

A Paediatric Early Warning system was implemented. Specific attention was given to developing the out of hours cover so that patient safety was maintained. A multidisciplinary Hospital @ Night (H@N) team was developed, and bleep-filtering was trialled.

Results Total hospital commitment is required to achieve solutions which meet local service requirements.

Rota planning was difficult particularly within teams with unfilled posts or providing regional cover over several sites.

Collaborative working within H@N worked well. Demonstrated benefits included increased practical support, improved communication and team-working. Bleep-filtering identified that a proportion of the out of hours work was non-urgent and could be carried out by senior nurses with additional training. The multidisciplinary collaborative model of working could be implemented effectively to the entire out of hours period. Longitudinal data from bleep-filtering can be used to further develop the out of hours clinical cover so that there is optimum resource utilisation.