Effects of consultant residence out-of-hours on acute paediatric admissions Robert Scott-Jupp (Consultant Paediatrician) Emily Carter (Senior Information Analyst)

Background Acute units require 24hr skilled medical cover – hard to achieve given staff resources SDH has had Resident Consultants since 2007 Out-of-hours resident cover split between four level 2/3 trainees and 6 (later 10) consultants Early consultant review more costly but may reduce admissions

Hypothesis Consultant resident shifts will result in fewer admissions than those where middle-grade doctor resident Nights (22:30 – 08:59) and Weekend Days (Sat & Sun; 09:00 – 22:29)

Methods Rotas from 2007 – 2017 examined Number of admissions per shift obtained from Hospital EPR system – ≥4hrs LOS only Admissions split into long and short stay (> or < 12 hrs)

Nights vs weekend days n Cons shifts Non-cons shifts Nights 4233 1.64 1.57 Weekend days 1511 2.12 2.13* Mean admission rates per shift, *= no sig difference

Length of stay Length of stay n Cons shifts Non-cons shifts > 12 hours 3213 1.83 1.89* < 12 hours 2531 1.60 1.64* Mean admission rates per shift, nights and weekend days. *= no sig difference

Statistical Analysis Interesting result: Patients 12 % more likely to be admitted when Consultant resident (Nights only) Table 1: Truncated negative binomial regression results   IRR (95% CI) SE P value Weekend Day vs Night Shift 0.58 (0.54 - 0.62) 0.02 <0.001 Stay < 12 hrs vs > 12 hrs 1.32 (1.24 - 1.42) 0.05 Consultant Resident vs Non-Consultant Resident 1.07 (1.0 - 1.14) 0.04 0.060 Crucial result: No statistically significant difference between Consultants and Non-Consultants when adjusted for the impact of other variables i.e. time and length-of-stay (multivariate analysis). Nor is there a difference on its own (univariate analysis).

Findings Resident consultant presence NOT statistically associated with reduced admission rates Further study may show evidence of a benefit by way of reduced needs for investigations and increased patient satisfaction

Possible explanations for lack of effect Benefit of early consultant review mostly at 21.00 handover, not measured here? Consultants more cautious than MG doctors? Reluctance of Tier 1 doctors to call Resident Consultant during night? Consultants less likely to be already present on ward when children arrive?