G213(P) What doctors do: an evaluation of the workforce

Abstract

Introduction Concerns about workload and its impact on training are widespread whilst there is limited evidence-based guidance on staffing requirements. The aim of this study was to evaluate the medical staffing in a tertiary neonatal unit (NNU) to aid informed workforce decisions. Methods We observed medical staff once for each of the different shifts on the rota over a two-month period; we mapped tasks to patient, location and time and categorised them. In addition, we reviewed routine tasks during the working week and at weekends. We used the data to measure efficiency as percentage of available time used on patient-related activities, calculate time required per patient depending on their level of care, and identify those tasks suitable for skill-sharing. We then implemented changes and re-mapped staff activity. Results Most time was spent on note-keeping and communication (54 hours, 30.5%), whilst least time was spent directly with patients (16 hr48min, 9.5%). 29% of breaks and 27% of teaching sessions were missed. We noticed a discrepancy between the requirements and the presence of weekend postnatal ward (PNW) staff. At night, the tier one spent two thirds of their time on labour or postnatal wards. Efficiency was better at higher levels of care for both tier one (intensive care (ITU) 89.5% versus PNW 83.9%) and tier two (ITU 88.6% versus PNW 76.6%). Daily time spent per patient averaged at 104 min on ITU, 62 min on high dependency, 28 min on special care and 30 min on PNW. Time spent on tasks suitable for skill-sharing ranged between 30% to 60%. Following changes, time spent with patients remained similar (9.6%) whilst tier two efficiency improved on PNW (81.3% versus 76.6%) and HDU (76.9% versus 74%), and tier one time spent on PNW patients at weekends increased (95% versus 69%). Conclusion Observational time motion studies are a useful tool to make informed decisions about the workforce. We identified inefficiencies that we then addressed, as well as activities suitable for skill-sharing, freeing up valuable time for junior doctors.