Improvement in out-of-hours outcomes following the implementation of Hospital at Night

Abstract

Background: Hospital at Night (HΝ) is a Department of Health (England) driven programme being widely implemented across UK. It aims to redefine how medical cover is provided in hospitals during the out-of-hours period. Aim: To investigate whether the implementation of H@N is associated with significant change in system or clinical outcomes. Design: An observational study for 14 consecutive nights before, and 14 consecutive nights after the implementation of H@N. Data were collected from the Combined surgical and medical Assessment Unit (CAU), the 18 medical/surgical wards (The Ward Arc) and the four High Dependency Units (The Critical Care corridor) within the Royal Infirmary of Edinburgh. Methods: Following an overnight episode of clinical concern, data were gathered on response time, seniority of reviewing staff, patient outcome and the use of Standardized Early Warning Score (SEWS). Results: Two hundred and nine episodes of clinical concern were recorded before the implementation of HΝ and 216 episodes afterwards. There was no significant change in response time in the CAU, Ward Arc or Critical Care corridor. However, significant inter-speciality differences in response time were eradicated, particularly in the Critical Care corridor. Following the implementation of HΝ, patients were reviewed more frequently by senior medical staff in CAU (28% vs. 4%, P < 0.05) and the Critical Care corridor (50% vs. 22%, P < 0.001). Finally there was a reduction in adverse outcome (defined as unplanned transfer to critical care/cardiac arrest) in the Ward Arc and CAU from 17% to 6% of patients reviewed overnight (P < 0.01). SEWS was more frequently and accurately recorded in CAU. Conclusion: This is the first study that we are aware of directly comparing out-of-hours performance before and after the implementation of HΝ. Significant improvements in both patient and system outcomes were observed, with no adverse effects noted. © The Author 2009. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved.