Review of on-call duties of non-consultant hospital doctors in a rural Irish psychiatric unit

The European Working Time Directive is a welcome challenge to traditional out-of-hours medical working practices, and aims to safeguard both doctors’ and patients’ health and safety. Its implementation is delayed in the Republic of Ireland because of ongoing medical union negotiations. Implementation of the directive will mean examination of on-call rotas, training requirements, and the organisation of cover. Local data determining clinical workloads after hours are the starting point to identify areas of concern and to implement appropriate solutions in individual locations.

We examined the out-of-hours calls of non-consultant hospital doctors (NCHDs) from 17.00 h to 09.00 h on weekdays and all day at weekends over a 4-week period, representing a total of 512 h. After midnight, the number of calls to doctors was less than a sixth the number before midnight (10 v. 64%). The majority of calls (68%) were for patient assessment and review, but a significant proportion related to non-medical work such as phlebotomy (8%) and filing (1%), and non-urgent work, such as the rewriting of prescriptions and the charting of medication (16%). Of all calls, 88% were appropriate to the skill level of the doctor contacted, however 9% required less skill and 2% were judged to be non-medical. Only 1% of calls were from general practitioners.

The restricted access of NCHDs to clinical supervision and training opportunities with shift working could be mitigated by high quality training in the evening and a reduction in time spent on non-training tasks. The new models of working are an opportunity to improve coordination of care between medical, nursing and other staff. Resources must be focused on the correct solutions, not just recruitment of additional medical staff. Above all, current available services and quality of patient care and safety must not be compromised.