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

2. 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

3. 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)

4. 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)

5. 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

6. 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

7. 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 ( )
0.02
<0.001
Stay < 12 hrs vs > 12 hrs
1.32 ( )
0.05
Consultant Resident vs Non-Consultant Resident
1.07 ( )
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).

8. 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

9. Possible explanations for lack of effect
Benefit of early consultant review mostly at 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?