Out Of Hours Research Articles

ThP7.3 - Time of admission has no impact on outcome in trauma laparotomy

Abstract Introduction Trauma laparotomy outcomes are influenced by both patient and system factors. Out of hours (OOH) is associated with reduced staffing and on-site seniority which may impact patient outcomes. We aimed to establish if OOH laparotomy is associated with poorer outcomes. Methods A retrospective analysis was performed on all patients that underwent a trauma laparotomy at a major trauma centre between 2019 and 2023. Groups were divided into in-hour admission (IH) (08:00 - 20:00) and OOH (20:00– 08:00). The primary outcome was mortality and secondary outcomes included intensive care and total length of stay. Statistical analysis was performed to determine differences between groups. Results 176 patients were included. The majority (62.5%) were OOH and penetrating the commonest mechanism of injury in both OOH (63.6%) and IH (57.5%). Comparing those admitted OOH and IH there was no difference inactivation of code red protocols (42.7% vs 39.4% p=0.663). ITU admissions (36.3% vs 43.9% p=0.318), length of ITU stay (mean days 9.1 ± 11.1 vs 15.7 ±17.4 p=0.068), total hospital stay (mean days 14.4 ± 25.3 vs 19 ± 25.4 p=0.204) or mortality (7.3% vs 4.5% p=0.469). Conclusion Although a larger proportion of trauma laparotomies occur in the OOH period, no statistical difference was found in any patient outcomes. This is likely due to established processes in our mature trauma model.

Emergency leadless pacing implantation is feasible and safe out-of-hours

Abstract Introduction Leadless pacing is increasingly used in patients with contraindications to transvenous systems. However, a common presentation of life-threatening bradyarrhythmia is in the out-of-hours emergency setting. The perceived complexities of leadless implantation anecdotally inhibit their use as destination devices implanted in the acute setting. Our centre offers a 24-7 emergency pacing service, we examined our use of leadless pacemaker implantation for patients requiring out of hours emergency pacing at our centre from December 2021 to December 2023. Purpose The purpose of this study looking to examine the feasibility and safety of leadless pacing in out of hours emergency situations. Methods This is a single centre retrospective cohort study examining all patients (pts) undergoing leadless pacemaker implantation at 1 hospital. Out of hours (OOH) implantation was defined as being after 18:00 during the week and any time during the weekend. Clinical and procedural parameters were compared between in-hours and out of hours (OOH) implantation. Haemodynamic instability was defined as any patient requiring inotrope support. Results 118 leadless pacing systems were implanted between 0/1/12/2021 and 01/12/2023; 95 being performed in-hours and 23 OOH. Pacing indication was high-degree AV block in 20 pts (87%) in the OOH group, with frailty (8pts), dialysis (4pts) and infection (3pts) being listed as the most common reasons for selection of a leadless system in the OOH group. OOH pts had greater haemodynamic instability [in-hours: 3pts (3.2%) vs OOH: 4pts (17.4%)]. Procedural time (mean ± Standard deviation, mins) was similar between groups [52.4 (±3.6) in-hours vs 59.7(+/- 6.4) OOH; p= 0.33] as was fluoroscopy time (mins) [in-hours: 4.9 (+/- 1.0) vs OOH: 5.1(+/- 2.3) p=0.97] and radiation dose (cGy*cm²) [in-hours: 56.73 (+/- 9.87) vs OOH: 53.8(+/- 14.1), p=0.89]. 3 (3.1%) major complications occurred in the in-hours group [tamponade (2pts), infection (1pt)]. One pt in the OOH group had a significant post procedure access site bleed (4.3%), but no tamponade occurred in this group. Four pts (4.2%) died before discharge in the in-hours group, four patients (17.4%) died in the OOH group, reflecting their poor premorbid condition. Conclusions Leadless pacemakers can be safely implanted in the emergency, out of hours setting. In selected patients, this technology can offer an immediate destination therapy as an important alternative to placing a temporary system.

1725 From care home to the emergency department; a snapshot of frailty admissions

Abstract Background Care home residents form a large number of admissions to the Emergency Department (ED). Over an 8-month period, care home admissions to ED were reviewed, examining the nature of admissions to inform how to improve current pathways. Method Patients with a frailty score ≥6 (N=180), admitted from 34 care homes to Chelsea and Westminster Hospital ED over 6 months were included. Data was collected from medical and London Ambulance Service (LAS) records. Data collected included; Presenting Complaint (PC), LAS attendance times, prior discussion with a Health Care Professional (HCP), Length of Stay (LOS). Results LAS attendances during normal working hours (9am-5pm Monday- Friday) formed 34% (N=61) of admissions with only 43% (N=26) being discussed with an HCP prior to attendance. Of these, 30% (N=18) were discharged <24hrs and up to 39% (N=7) of these may not have required emergency admission. For all admissions, ‘fall’ was the most common PC, 33% (N=59) followed by ‘respiratory issue’ 21% (N=38). Overall, 24% (N=47) of total admissions were discharged <24hrs but total care home admissions accounted for a total of 454 bed stay days. Factors impacting discharge included COVID status, requiring care home re-assessment prior to discharge and no longer having a bed available. Conclusion This data demonstrates that there is an opportunity to improve care home support and admission pathways. Discussing patients with an HCP prior to contacting LAS may reduce requirement for ED attendance alongside access to rapid response community teams. Expanding an HCP accessible service out of hours (OOH) could facilitate this and implementing a frailty telephone service may also support with this initiative. Collaboration with care homes and community partners will form the next steps in this quality improvement work.

Lyme Disease General Practice Sentinel Scheme.

Lyme Disease (LD) is a multisystem zoonosis with uncertain epidemiology. It may be increasing in rural hotspots. GP datasets are weakened by coding and definitions. Public and climate concerns have raised awareness of LD. Improving diagnostic coding, UK Lyme Disease incidence and distribution. Behavioural risk factors for public health policy. Education modules for 35 general practices from Orkney to Southampton.Remote installation of software providing decision support, case definitions, pictures, coding, prescribing guidelines. Questionnaire on tick exposure and removal methods. Anonymous data extraction.Data on tick bite body location, age, place of exposure, attachment time, removal methods, leisure pursuits and occupation to guide public health policy.GP data capture and coding from hospital, A&E and OOH (out of hours) records.Erythema Migrans (EM) is a clinical diagnosis without serological testing. Rash photographs establish a data bank of disease expression in age groups, ethnicity, and skin types. There were 69 cases reported in the pilot period (September to December 2021), 52% diagnosed EM following a definite tick bite. Tick attachment time showed a majority > 24 hours, with home tweezers, fingernails often used for removal, with both associated with higher disease transmission.Analysis of pilot data suggested a Lyme Disease incidence of 94/100 000 with the inclusion of EM. This compares to a serologically confirmed incidence of 38.2/100 000 in 2019 in Highland Region. Early data suggests that the Lyme Disease General Practice Sentinel Scheme has improved case ascertainment, epidemiology, and risk factor understanding.

Specialist palliative care out of hours telephone advice in Ireland: a national survey

ObjectivesIn 2015 the All-Ireland Institute of Hospice and Palliative Care identified access to specialist palliative care (SPC) advice out of hours (OOH) as their number one research priority. Receiving appropriate...

Supporting older people following out of hours discharge from the Emergency Department: An integrative review of the literature.

For many older people the emergency department (ED) is an important but sometimes difficult step in their healthcare journey. They often attend the ED with co and multi morbidities. Discharge home at evenings and weekends when post-discharge support services are limited can result in a delay or failure to follow through on their discharge plan leading to adverse health outcomes and in some cases, readmission to ED. The aim of this integrative review was to identify and appraise the support available to older people following discharge from the ED out of hours (OOH). For this review, out of hours referred to those times after 17.30 until 08.00 a.m. on Mondays to Fridays, all hours on weekends and public holidays. Whittemore and Knafl's (Journal of Advanced Nursing, 2005;52:546), framework was used to guide all stages of the review process. Articles were retrieved following a rigorous search of published works using various databases, the grey literature and hand search of the reference lists of the studies included. In total 31 articles were included in the review. These comprised systematic reviews, randomised control studies, cohort studies and surveys. Main themes identified included processes that enable support, support provision by health and social care professionals and telephone follow-up. Results identified a significant dearth of out of hours discharge research and a strong recommendation for more concise and thorough research in this important area of care transition. Older person discharge home from the ED presents an associated risk as previous research has identified frequent readmission and periods of ill health and dependency. Out of hours discharge can be even more problematic when it may be difficult to arrange support services and ensure continuity of care. Further work in this area is required, taking cognisance of the findings and recommendations identified in this review.

Implementation of a Children's Safe Asthma Discharge Care Pathway Reduces the Risk of Future Asthma Attacks in Children-A Retrospective Quality Improvement Report.

BackgroundMany children attend Emergency Departments (ED) and Out of Hours (OoH) frequently for acute asthma. Follow up care is often suboptimal leaving these children at risk of a future attacks. We report on the development, implementation and evaluation of a safe asthma discharge care pathway (SADCP).MethodsThis is a retrospective report on the development, implementation and evaluation of outcomes of a SADCP. The pathway was based on the Teach-to-goal educational methodology that supported the mastery correct inhaler technique and ability to action the personalized asthma action plan (PAAP). Children with frequent asthma attacks were entered as they were discharged from the Emergency Department or ward. The first training session occurred within 1–3 weeks of the index asthma attack with 2 further sessions in the following 8 weeks. Children exiting the pathway were discharged either back to primary care or to a hospital clinic.Results81 children entered the pathway (median age 5 years) with 72 discharged from the ED and 9 from the medical wards of the Royal Belfast Hospital for Sick Children. At pathway entry 13% had correct inhaler technique, 10% had a Personalized Asthma Action Plan (PAAP), and 5% had >80% (45% >50%) repeat refill evidence of adherence to inhaled corticosteroid over the previous 12 months. On pathway exit all children demonstrated correct inhaler technique and were able to action their PAAP. One year later 51% and 95% had refill evidence of >80% and >50% adherence. Comparisons of the 12 months before and 12 months after exit from the pathway the median number of emergency ED or OoH asthma attendances and courses of oral corticosteroids reduced to zero with >75% having no attacks requiring this level of attention. Similar findings resulted when the SADCP was implemented in a district general hospital pediatric unit.ConclusionImplementing an asthma care pathway, using Teach-to-Goal skill training methods and frequent early reviews after an index asthma attack can reduce the future risk of asthma attacks in the next 6 to 12 months.

Clinician perspectives on having point of care tests made available to them during out of hours home visiting

BackgroundLittle is known about clinicians’ perspectives on the use of point of care (POC) tests in assessment of acute illness during primary care out of hours (OOH) care. During a service improvement project, POC tests (including creatinine, electrolytes, haemoglobin and lactate) were made available to clinicians undertaking OOH home visits, with the clinicians allowed absolute discretion about when and whether they used them.MethodTo explore clinicians’ perspectives on having POC tests available during OOH home visits, we undertook a qualitative study with clinicians working in Oxfordshire OOH home visiting teams.We conducted 19 Semi-structured interviews with clinicians working in OOH, including those who had and had not used the POC tests available to them. To explore evolving perspectives over time, including experience and exposure to POC tests, we offered clinicians the opportunity to be interviewed twice throughout the study period. Our sample included 7 GPs (4 interviewed once, 3 interviewed twice - earlier and later during the study), 6 emergency practitioners (EPs) including advanced nurse practitioners and paramedics, 1 Healthcare Assistant, and 2 ambulatory care physicians. Interviews were audio-recorded, transcribed verbatim and analysed thematically.ResultsThe clinicians reflected on their decision-making to use (or not use) POC tests, including considering which clinical scenarios were “appropriate” and balancing the resources and time taken to do POC tests against what were perceived as likely benefits. The challenges of using the equipment in patients’ homes was a potential barrier, though could become easier with familiarity and experience. Clinicians who had used POC tests described benefits, including planning onward care trajectories, and facilitating communication, both between professionals and with patients and their families.ConclusionClinicians described a discriminatory approach to using POC tests, considering carefully in which situations they were likely to add value to clinical decision-making.

Increase in Anxiety-Related Out-of-Hours Primary Care Consultations Since COVID-19: An Observational Study Using Routine Data in Flanders.

Background: Survey studies suggest that COVID-19 has had a negative impact on the population's mental well-being. Routine registration data allow a more objective way for investigating such associations, complementary to self-report measures. This study investigates the level of out of hours (OOH) consultations for psychological problems since the start of the COVID-19 pandemic in Flanders, Belgium. Methods: The iCAREdata database is a clinical research database with routine data of OOH care, covering a large area in Flanders, Belgium. After defining the first wave and the second wave of COVID-19 in Flanders in time, we compared the number of consultations regarding psychological problems (in general, anxiety-related, depression-related, and sleep-related) between those periods, the period in between these waves, and the period before the start of COVID-19. Results: A significant rise in OOH consultations due to psychological-and more specifically, anxiety-related-problems is observed since the start of the COVID-19 pandemic in Flanders. Elevated levels are observed until the second wave. This finding is in sharp contrast with the general pattern of lower demand for primary healthcare during this period. The majority of these supplementary consultations happened by phone. Consultations regarding depression-related problems did not change over time. Sleep disturbances in the OOH setting were more common after the first wave. Conclusion: Despite some limitations, a large Flemish database with routine data on OOH care shows an increase in the number of consultations regarding psychological problems in general and anxiety-related problems since the start of the COVID-19-pandemic until the second wave.

Non-urgent emergency department attendances in children: a retrospective observational analysis

IntroductionA significant proportion of ED attendances in children may be non-urgent attendances (NUAs), which could be better managed elsewhere. This study aimed to quantify NUAs and urgent attendances (UAs) in...

Dental core training in oral and maxillofacial surgery: a United Kingdom survey of on-call provision.

Introduction Dental core training posts within oral and maxillofacial surgery (OMFS) units often include on-call provision. There is a lack of current data demonstrating the variation of dental core trainee (DCT) involvement in on-call. This variation may influence trainees' experience of training.Aim To examine the provision of on-call cover in OMFS units across the United Kingdom, including trainee involvement, supervision and training.Method Online surveys were distributed in August 2019 to all DCTs, educational supervisors (ESs) and training programme directors (TPDs) in OMFS units to understand trainee involvement in on-call provision, including levels of supervision and perceived educational benefit.Results In total, 167 trainees responded from 69 OMFS units. Responses were received from 102 ESs/TPDs. All trainees experienced on call, with over 75% covering night shifts. Trainees reported minimal difference between support within hours and out of hours (OOH). Qualitative data from trainees and supervisors highlighted the educational value of on-call within normal hours. However, limited supervised training opportunities were reported OOH.Conclusion This survey highlights the educational value of on-call within hours. The perceived level of support does not vary significantly between normal hours and OOH. Some concerns were expressed regarding OOH supervision and prolonged on-call periods.

Implementing out of hours MDT safety huddles at the Ladywell Unit, Lewisham, South London and the Maudsley (SLAM) NHS Foundation Trust

Aims•For 100% of patients admitted OOH (Friday 5pm – Sunday 9am) to have a multi-disciplinary review of their treatment•For 100% of patients with deteriorating physical and mental health to be discussed•To improve multi-disciplinary team (MDT) morale, working relationships and team cohesiveness OOHBackgroundIn most specialties, the standard of best practice is that patients admitted to the ward out of hours (OOH) receive a senior review over the weekend. However this does not usually take place in Psychiatry, and patients routinely wait until Monday to be seen by the ward team. This has been highlighted as problematic in cases where patients are agitated and not receiving any treatment for > 24 hours.We trialled a weekend teleconference safety huddle in Lewisham involving the on call consultant, registrar (SpR), core trainee (CT) and duty senior nurse (DSN).MethodThe weekend huddles were through a teleconference line, with participants dialling in at 9.45am.Issues discussed: 1)Management plan for newly admitted patients OOH.2)Plan for patients with deteriorating mental health or escalating level of aggression.3)Plan for patients with deteriorating physical health.Feedback was collected from CTs, SpRs and consultants focusing on whether the huddle made any difference to the speed of care, cohesiveness of the OOH team, and whether it was generally helpful or not.Result54% of CTs (n = 11) felt that patients admitted OOH had an MDT review, and 90% felt that patients with deteriorating mental and physical health were discussed and a plan put in place. 80% of CTs, 63% of SpRs (n = 8) and 67% of consultants (n = 6) agreed it improved team cohesiveness. 90% of DSNs felt safer and more supported in decision-making OOH.80% of CTs, 63% of SpRs and 83% of consultants found weekend huddles helpful.Data were also collected on violent incidents OOH, and there was a slight reduction in the number of violent incidents in the weeks following introduction of the huddle.ConclusionIntroducing safety huddles in Lewisham has facilitated the prompt discussion of the management of patients admitted OOH, and of those with deteriorating mental and physical health. It has also fostered a greater sense of cohesiveness in the MDT team.In light of this feedback, safety huddles have now been established as part of the weekend schedule in Lewisham, and are being rolled out to other boroughs within SLaM.

Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh

AimsCOVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.

Forty-eight-hour hospital mortality: an emergency department perspective studying the relationship between suboptimal care and mortality

Background: Patients have been recognised to suffer from adverse events if they receive suboptimal care in an acute healthcare setting. The main aim of this study was to ascertain the quality of care delivered to patients who are admitted via an Emergency Department and die within 48 hours of hospital admission. A second aim was to determine if patient admission to the Emergency Department (ED) at the weekend or during out of hours (OOH) resulted in suboptimal care.

Investigating staff perceptions and experiences of telephone triage in general practice

In this qualitative study, Alexandra Detheridge investigates the use of telephone triage in a general practice home visiting team Background: Telephone triage (TT) has historically been used in out of hours (OOH) provision for managing patients who require telephone advice or assessment face-to-face. It is increasingly being used in primary care to manage demand and advanced nurse practitioners are well placed to support this. Aims: To investigate staff perceptions and experiences of TT, barriers, role development, patient expectation and how care could be improved. Methods: Semi-structured interviews were completed with 8 staff (3 specialist nurses and 5 GPs) in a general practice home visiting team that provides care to 46 000 patients. Findings: TT use requires training and support for staff. While communication and patient engagement can be barriers, teamwork is a valuable means of improvement. Conclusion: TT enables the patient to see the correct clinician and can support care management in general practice.

P58 Managing access to ‘Out Of Hours‘ medications in a tertiary paediatric hospital

AimsMany UK and Irish hospitals provide a Monday to Friday pharmacy service; automated dispensing cabinets and hospital-wide information systems remain uncommon. Locating and accessing out of hours (OOH) medications can be a significant workload for nursing staff. In an Irish 230-bed tertiary paediatric hospital processes involve: nursing staff contacting other wards by telephone to source items; completion of an ‘Out of Hours Requisition’; and either transferring stock between wards or contacting nursing administration staff (NAS) to access stock from the Pharmacy Department. A quality improvement project was undertaken to: measure current levels of OOH medications; identify areas for improvement; implement and assess impact of new processes.Methods‘Out of Hours Requisition’ data were entered into a custom-built database and analysed for the period January - December 2018. The findings were discussed with nursing staff and NAS. Improving processes for locating medications was identified as a key area for improvement. The ‘Out of Hours Requisition’ form was amended to provide clearer instructions for completion. Using data from clinical area stock lists, a searchable Medicines Locator Database was developed and made accessible to all staff in the pharmacy department, clinical areas and the NAS office in December 2018 enabling staff to remotely identify the location of all medications stocked in the hospital. Data for ‘Out of Hours Requisitions’ for the period January - May 2019 were collated, analysed and compared with data from the same time period in 2018 (January - May). Microsoft Excel® was used for data collection, analyses and development of the Medicines Locator Database.ResultsA total of 1747 OOH medications were accessed by NAS from pharmacy in 2018, 746 during the period January - May 2018. Anti-microbial agents (36%) were most common, with requests originating from 16 clinical areas. Request from the paediatric intensive care units (36%) and the surgical/orthopaedic ward (36%) were most frequent. 515 medications were accessed in the first 5 months after the introduction of the Medicines Locator Database (January - May 2019). This represents a 35% reduction in the number of medications dispensed in the same time period in 2018. No changes to the types of medications were identified, but some differences in clinical areas were found.ConclusionThis significant reduction (35%) in numbers of medications accessed out of hours, and the corresponding reduction in workload for NAS, demonstrates the benefits of reviewing medication management processes. Further substantial time savings for nursing staff locating stock at ward level are likely. Readily-available technology can be successfully employed to improve processes in the absence of more sophisticated technological solutions. A staff survey is planned to evaluate awareness and usability of the database and identify further areas for improvement.

Clinical utility of plain-film abdominal radiographs for inpatients outside standard working hours in a large university teaching hospital

IntroductionPlain film abdominal radiographs (PFAs) are frequently the initial investigation ordered for patients with abdominal symptoms. However, increasing use of emergency ultrasound and availability of emergency CT raises the question of whether PFA remains an appropriate first line investigation. We investigated the impact of out of hours (OOH) PFAs on inpatient management. MethodsAll consecutive PFAs over an 8-week period were included to determine the impact on patient management. OOH was classified as from 5pm to 9am Monday to Friday, weekends and bank-holidays. PACS and hospital records were accessed to determine patient pathways. The institution is a tertiary referral centre with 850 acute beds and serves a population of 950,000. ResultsA total of 758 consecutive PFAs were performed in total (58.3% male, mean age 58.1 (range 0–93)). 310 (40.9%) were requested from the emergency department (ED) and 382 (50.4%) were requested from wards. 160 (21.1%) met the criteria of OOH, of these 120 (72.2%) were from ED and 28 were on adult inpatients. Of these 28, none had a change in management based on the PFA result. ConclusionOur study suggests that OOH PFAs of inpatients are of limited clinical utility. These patients are exposed to extra radiation. Implications for practiceWe propose that OOH PFAs of inpatients should be questioned as a viable investigation due to the limited contribution they offer in managing patients, the deleterious effects they confer on the patient and the associated economic cost. Further studies are needed to assess if these results are generalizable to other large hospitals.

Out of hours, out of sight? Uncovering the education potential of general practice urgent care for UK undergraduates

ABSTRACT There is a need to increase undergraduate primary care exposure and subsequently enhance primary care recruitment. This study aimed to establish the current use and education potential of the primary care out of hours (OOH) learning environment. This was a mix methods study. A questionnaire was sent to UK primary care heads of teaching nationally to explore the current use of GP OOHs in the undergraduate curriculum and focus groups evaluated final year medical students’ experience of an OOH placement. There was a 100% response rate from primary care heads of teaching. Despite 86% being in favour of integrating OOH placements within the undergraduate curriculum, only 28% of medical schools currently offer primary care OOH placements. 36 out of 240 students volunteered for a clinical OOH session. Focus group data from 6 of these students revealed that the placements provided unique learning opportunities and allowed students to appreciate the organisational structure of the National Health Service (NHS). However, barriers included logistical difficulties with the OOH providers and inadequate supervision. It appears that we are overlooking a unique educational opportunity for medical undergraduates. With increasing demands for GP exposure within the undergraduate curriculum, GP OOH is a useful resource for UK medical schools.

An interview analysis of coordination behaviours in Out–of–Hours secondary care

This paper seeks to elicit and structure the factors that shape the execution and, in particular, the coordination of work in Out of Hours care. Evenings and weekends in UK hospitals are managed by specific Out of Hours (OoH) care arrangements, and associated technology. Managing care within the constraints of staff availability and demands is a key concern for both patient care and staff wellbeing, yet has received little attention from healthcare human factors. A study of sixteen clinical staff used Critical Decision Method to understand how work is coordinated and the constraints and criteria that are applied by the roles managing OoH care. The analysis identified ten types of coordination decision that, in turn, underpinned three types of adaptive behaviour – pre-emption, information augmentation and self-organisation – that were crucial for the effective performance in OoH care. These behaviours explain how OoH staff manage the task demands placed on them, individually and as a team.

Impact of Emergency Medicine Consultants and Clinical Advisors on a NHS 111 Clinical Assessment Service

ObjectiveTo compare outcome of clinical advice given by emergency physicians (EPs) versus non-physician clinical advisors (NPCAs) on a UK National Health Service 111 centre.MethodThis was a prospective study conducted between...