Hospital Dr News

Consultants sign up to new seven-day rota

Consultants at a West Midlands trust have agreed to work a seven-day rota in a drive to cut weekend deaths.

Eight additional consultant physicians at a cost of £1m will be recruited by The Royal Wolverhampton Hospitals Trust (RWHT) to counteract the “weekend effect” on patients admitted as medical emergencies.

The trust, which runs New Cross Hospital in Wolverhampton, has one of the highest deaths rates in the country for patients admitted at the weekend. According to the Dr Foster Hospital guide, RWHT currently has a 13% higher standardised mortality rate (SMR) at weekends compared to weekdays.

The trust has had a high weekend SMR since 2005. The figures have been under scrutiny by the Care Quality Commission for the last four years although investigations have failed to identify any significant issues within the trust which have been thought to contribute to the patient deaths.

Medical director Dr Jonathan Odum says the reasons for the higher death rates for patients admitted at the weekend are unclear and are probably multi-factorial.

But in a report to the trust board he says he is concerned that senior medical cover across clinical areas at the weekend is provided on an on-call basis and is therefore more “sparse” than compared with routine weekday cover. “The worry is this may contribute to a difference in clinical care patients receive over the weekend compared with weekdays,” he said.

He adds that consultant physicians are keen to introduce a seven-day rota to ensure ward rounds are routinely undertaken on all medical wards every weekend and on all bank holidays. Consultants in gastroenterology and renal medicine at the trust already provide cover for their wards at the weekend with proven improvements in quality and safety for patients.

Dr Odum said: “The potential benefits of introducing seven-day working across the medical sub specialities and the potential benefits are enormous.”

The trust has agreed to appoint three new care of the elderly consultants, two respiratory consultants, one diabetes consultant, one renal consultant, one acute physician consultant and a 0.2 whole time equivalent oncology consultant.

In his paper to the trust board Odum says several large studies over the last decade have identified significantly increased hospital mortality rates for medical patients admitted as an emergency over a weekend.

The most recent, published earlier this year in the Journal of the Royal Society of Medicine, identified an 11-15% increase in mortality for patients admitted on a Saturday or a Sunday.

The RCP recommends that consultant physicians should be available on-site for at least 12 hours a day, 7 days a week in order to improve the care of acutely ill patients.

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2 Responses to “Consultants sign up to new seven-day rota”

  1. Supersub says:

    Hmmm… they’re jumping the gun slightly. Or maybe this is a ruse by the consultant body there to get a few extra colleagues?

    The case for all of this is far from proven. Even that cited study shows an excess of deaths if ADMITTED at the weekend but the actual excess of deaths occurred mid-week.
    In other words, the deficiencies are probably in the pre/peri-admission managemnt.

    So why on earth are consultants all jumping to work Saturdays and Sundays when this could just as easily be explained by poor Primary Care access at weekends?

    If the Royal College of Physicians were interested in getting some half-decent data on this (rather than just “opinion”), they could easily organise a randomised controlled trial – 7 day consultants versus 5 day and resolve this.
    But that wouldn’t get a load of extra consultants employed now would it?

  2. Malcolm Morrison says:

    Whether or not the statistics show what they have been interpreted as showing, anything that, at last, gives a priority to the care of emergencies over ‘elective cases’, and gets consultants involved in their care, must be a good idea.

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