Out Of Hours Workload Research Articles

57 The Workload Distribution and Response Times of FAST Scans in a Level 3 Hospital in Ireland

Abstract Background With the advent of time sensitive treatments like thrombolysis and thrombectomy for acute ischaemic stroke, it would be expected that stroke CT would place an increased demand on CT services out of hours. Our aim is to demonstrate the change in the workload distribution in the investigation and management of acute stroke over the last year. Methods Data was collected from the radiology systems used in our hospital (NIMIS/PACS). Firstly, CT multiphase angiograms done between 17/10/2017 and 17/10/2018 were examined, followed by all FAST-positive CT brains in the same period. Arrival times for FAST positive patients were collected from the ED Symphony system. These details were used to calculate time to CT and time to report in hours and minutes. Scans were categorised into 5-time windows, in and out of hours. The process was repeated for CT brain and all other CT scans for comparison. Results 58.14% of all FAST-positive CT scans were performed out of hours. FAST positive scans accounted for 9.49% of all out of hour CT scans, this rose to 20% when examining the out of hour scans from Monday to Friday. The most common indication for non-FAST positive CT was trauma. There was a higher likelihood of receiving a CTA during hours as opposed to out of hours, (73.33% vs 66.94%). Median time to CT in FAST positive patients: window 1 – 30mins, window 2 – 49mins, window 3 – 49mins, window 4 – 34mins, window 5 – 39mins. Conclusion Stroke CT will continue to increase the out of hours work load for CT departments across the country especially with our ageing population. It is vital that services, particularly in level 3 stroke centres, are adequately equipped in terms of staffing to meet the highest standard of care in the management of acute stroke.

Excessive volume of trauma workload out of hours: is it really true?

To determine whether an excessive out of hours workload might contribute to the current lack of interest in trauma orthopaedics as a sub-specialty in the United Kingdom we reviewed data collected prospectively on 467 multiple trauma patients (ISS > 15) presenting to a teaching hospital over a 5 year period (January 1996–January 2001). Almost half of the patients (48.6%) presented between the hours of 18:00 and 08:00 with the trauma team called more frequently out of normal working hours. Two hundred and eleven (45.2%) patients underwent an operative procedure during their admission with an orthopaedic surgeon involved in the procedure in the majority of cases. Nearly half (41.5%) of these cases started between 18:00 and 08:00 with a larger portion (49.6%) finishing between these hours. A Consultant was the primary surgeon in 123 (82.0%) cases and involved in the majority of out of hours operating. Intensive care was required for 151 (32.3%) patients. The median hospital stay was 9 days (1–93). The out of hours workload for Orthopaedic consultants working in a busy teaching hospital is considerable. Planning issues need to be addressed to ensure that a career in trauma surgery is made attractive to current and future orthopaedic trainees.

An audit of out of hours interventional vascular radiology

Background: in 1996 the Royal College of Radiologists established a set of guidelines for out of hours radiology. Part of the recommendations determined that all units should regularly assess their own out of hours workload. In light of these guidelines we have audited our units interventional radiology activity. Methods: this was a retrospective study looking at the number of emergency angiograms and procedures performed over a 1-year period. Patients were identified from a vascular radiology database and case notes reviewed. Results: a total of 1902 patients had angiograms with 686 having further procedures. Of these, 1093 patients (57%) having 380 procedures (55%) were under the care of a consultant vascular surgeon. Of the vascular surgical patients only 17 patients (1.6%) were actually investigated out of hours (1700-0800 weekdays and at weekends). 5/17 (29%) patients received thrombolysis and 7/17 (41%) had either an angioplasty or stent. Despite being a major vascular unit only 2/17 (12%) were patients referred from outside the units own trust. Following diagnostic angiography, 13/17 (76%) of patients had an intervention performed within the first 24 h. Conclusion: in a unit performing a large number of angiograms only a small number of patients require out of hours emergency angiography and interventional vascular procedures. Our impression is that this is the result of a flexible and responsive in hour's service. At the present time extra-hospital referrals do not appear to generate large amounts of out of hours work. This level of out of hours activity has implications in the provision of vascular radiological services in the future.Eur J Vasc Endovasc Surg 25, 573-577 (2003)

Out of hours service in Denmark: evaluation five years after reform

Objective: Five years after its introduction, to evaluate the 1992 reform in the out of hours service in Denmark.Design: Comparison of data before and after reform. Data were collected from...

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey

Objectives: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department.Design: Six month longitudinal...

Out of hours workload of a suburban general practice: deprivation or expectation.

The out of hours workload of a training practice in a suburban and semirural area on the south coast of England was studied for one year. An overall rate of contact of 273/1000 patients was found, which indicated a workload greater than that reported in most other studies. The duty doctor received over 35 telephone calls from patients during some Saturdays (1200 Saturday to 0800 Sunday) and Sundays (0800 to 0800 Monday), up to five being between 2300 and 0700. Of the patients who contacted a general practitioner, 44% were given advice by telephone and 4.9% were admitted to hospital. The admission rate was lower than that given in other studies. A considerable proportion of the workload arose from doctors covering the casualty department of a cottage hospital. Patients having a high expectation of 24 hour care by general practitioners in an area of comparative affluence (Jarman indices -13.8 to 1.7) may account for this aspect of the workload.

Twenty four hour care in inner cities: two years' out of hours workload in east London general practice.

Two inner city general practices in east London jointly provide care outside normal working hours without using deputising services for about 14,000 patients. The statistics on workload were reviewed for 1987 and 1988. An overall rate of face to face consultations of 4.1 per patient per year was recorded, there being 115,965 consultations over two years for a mean list size of 14,174 patients. Four per cent (4737) of such consultations were outside normal working hours. The annual rate of visiting outside normal hours was 128.1 per 1000 patients in 1987 (1793 visits) and 131.5 per 1000 in 1988 (1888 visits). The rates of night visiting were 18.8 (262 visits) and 18.9 (271 visits) per 1000 patients in 1987 and 1988 respectively. Only 24% of all the requests for medical help out of hours (1483/6220) were dealt with by advice given on the telephone. The high rates of consultation outside normal working hours with only a small proportion being dealt with on the telephone alone may be explained by indices of deprivation. Local rotas for out of hours work are a good compromise between meeting the needs of patients and doctors in deprived areas, but there are financial implications for inner cities.

Restricted feeding and human intestinal plasma cell development.

Small intestinal mucosa from 129 necropsies and 15 surgical specimens from infants aged from birth to 21 months was examined for the presence of cells containing IgA, IgM, and IgG using the PAP immunoperoxidase technique. Immunoglobulin containing cells were nearly always absent in infants under 1 week of age but occurred in the second week of life in infants who had had milk feeds. At this time, IgM containing cells were predominant, but IgA containing cells were more numerous by the sixth week. IgG containing cells were generally sparse. Parenterally fed infants who had received little or no intestinal milk showed significantly fewer immunoglobulin containing cells than those who had been fed normally, irrespective of gestation. Lack of stimulation by food and bacterial antigens may contribute to immunoglobulin containing cells failing to occur in these parenterally fed neonates.