I am coming in on the end of this, but have been away so apologise to all
who are fed up with it. I wanted to go right back to the original qustion
about departments who have 24 hour cover.Last year Henry Guly and I looked
at the level of senior cover in the South West region ? 12 units in total,
but only 9 provided data. Departments range from 24500 ? 85000 / year. We
looked retrospectively at the rota for 2 random days ? midweek and weekend,
to see what level of staff were available to see new patients (i.e not in
meetings etc).

Midweek, we found that 8/9 have 24 hour SHO on site; 4 have 24 hour middle
grade, and 0 have 24 hour consultants. Only 5 actually had a consultant
at all in the day.

At the weekend, SHO and middle grade was the same but only 3 had a consultant
on the shop floor at any point.

There are 2 reasons for sharing this info:

The first is as part of Bruce?s initial question about providing 24 hour
cover (our department doesn?t ? SpR / Staff grade there until 0100, then
available from home: will change soon).

The other arm of the study looked at the seniority of the person seeing
patients and / or giving advice. Only 36% of new patients have someone more
senior than SHO involved in their care: most of these are seen first by
that doctor ? i.e. the SHOs aren?t asking advice very often. (Interestingly,
this is the same level of senior input as the only other similar study ?
done in 1962)

Hence, the second reason is to ask the group a question.

The study was designed to look at what level of senior input our patients
get. We believe that we operate a two tier system ? fine if you come 9 ?
5 mon to fri, but out of hours you get seen by a (usually junior) SHO. The
study was small (9 hospitals) but should provide a good baseline against
which to compare nationally. However, extracting the data as to who actually
saw the patients, and whether a patient had their care discussed with a
senior or not, was very difficult. In order to do a larger study (national?)
some form of electronic recording system seems the way ahead, so the database
can be interrogated. Anyone any bright ideas of such a system? HAS (our
system in Plymouth) can?t / oesn?t contain this info.

Unfortunately, DoH / emergency care reform groups have not been able to
assist. Any thoughts?

Lee Wallis
SpR, DMS A&E