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Original research
Effects of consultant residence out-of-hours on acute paediatric admissions
  1. Robert Scott-Jupp1,
  2. Emily Carter2,
  3. Nick Brown3,4
  1. 1 Department of Paediatrics, Salisbury District Hospital, Salisbury, UK
  2. 2 Information Services, Salisbury District Hospital, Salisbury, UK
  3. 3 Department of Women’s and Children’s Health, International Maternal and Child Health (IMCH), Uppsala University, Uppsala, Sweden
  4. 4 Department of Paediatrics, Länssjukhuset Gävle-Sandviken, Gävle, Sweden
  1. Correspondence to Dr Robert Scott-Jupp, Salisbury District Hospital, Salisbury, UK; scottjupp{at}virginmedia.com

Abstract

Acute paediatric units require round-the-clock skilled resident medical cover. Fully trained doctors remaining resident on-site at night and weekends may improve care at these times, but costs are higher. In compensation, more senior doctors may be less likely to admit children.

Methods In a unit providing 24-hour, 7-day acute services, out-of-hours resident cover has been divided between level 2/3 trainees and consultants. Between 2007 and 2017, night and weekend day shifts were identified as resident consultant or non-resident consultant. Admission numbers (duration of stay of ≥4 hours) were obtained from hospital activity databases. Analyses were undertaken on total admissions and stratified by time of day and duration of stay of >12 or < 12 hours. Incidence rate ratios (IRRs) were derived using negative binomial regression .

Results For all out-of-hours and short-stay patients, children were significantly more likely to be admitted when there was no resident consultant: IRRs 1.07 (95% CI 1.04 to 1.09) and 1.09 (95% CI 1.02 to 1.18), respectively. There was no difference between rates stratified into long stay at night or weekend days: IRRs 1.01 (95% CI 0.96 to 1.07) and 1.03 (95% CI 0.99 to 1.18) respectively .

Conclusion A resident consultant presence was associated with reduced total, night-time and short-stay admissions.

  • Paediatric Practice
  • Paediatric Staffing

https://doi.org/10.1136/archdischild-2019-317553

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    Footnotes

    • Correction notice This article has been updated since it was published online. Please see the updated author note.

    • Contributors RS-J conceived the project, developed the research methods and wrote the text. EC collated and analysed the data, with statistical support. NB did further analysis for the resubmission and advised on the final text.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data available from the authors.

    • Publisher note This article includes Editor-in-Chief Nick Brown as an author. To avoid a conflict of interest the Associate Editor Colin Powell handled the paper throughout the submission process.