Aim To look at the effect of the consultant delivered care in comparison to the registrar delivered care on the clinical services, patient care, satisfaction and staff opinion.
Method All the patients attending our paediatric assessment unit between 1130 am and 2100 were assessed on three consecutive days for two weeks. The parameters compared were the length of time taken to make a clinical decision from the time the patient was seen, investigations performed, any readmissions, patient outcome, any significant incidents, patient satisfaction and nursing staff opinion.
Results A total of 51 patients were analysed. 21 of them were seen by the consultants and 29 were seen by the registrars. The time taken for Consultants to make the clinical decision and management plan varied from 15 to 100 minutes with a median of 30 minutes and mean of 39.6 minutes. The registrars took 90 to 480 minutes for the clinical decision with a median time of 250 minutes and mean of 233 minutes. 4 (19%) and 16 (55%) patients seen by consultants and registrars had investigations respectively. 2 patients, seen by registrars, with Paediatric Early Warning Score of more than 4 were admitted after 280 min. One of these patients needed HDU admission and was transferred to specialist hospital. Another patient was diagnosed to have sepsis and had acute deterioration. 16 (76%) patients were discharged home and 5 (24%) patients were admitted by consultants. In the group seen by registrars or speciality trainees, 10 patients (34.5%) were sent home, 17 were admitted (59%) and 2 were transferred out. There was one readmission from the group seen by the speciality trainees Patients’ satisfaction survey was similar in both groups. Nursing staff in POAU felt there was quicker decision making and more precise plans when seen by the Consultants.
Conclusion The consultants made faster decision, performed less investigations and discharged more patients home with no readmissions or clinical incidents.