After hours care and safety: Wellbeing of patient and healthcare workers

March 14, 2021
Dr Sonia Chanchlani is the CMO at MedApps as well as a Clinician, Med Ed leader and Karaoke Master

After hours care and safety in hospitals is the subject of national and international research, yet it remains a challenge for patients, frontline healthcare workers and hospitals themselves. 

Over the year, studies1,2,3,4 have been exploring the underlying causes of the ‘weekend effect’ whereby data shows higher mortality rate for patients admitted as an emergency on weekends.

This concerning trend is paralleled by the fact that the hospital staffing profile typically changes after hours. 

Fewer doctors are available on site after hours and on weekends. The doctors are usually more junior and working with other less experienced medical staff on the wards. Additionally, fewer support services are available.

Why is after hours service affected when we know the consequences?

What I’ve described above was certainly my experience as a clinician and later in my role facilitating quality improvement projects. Both experiences revealed key elements may have been missing to deliver an optimal environment after hours for staff and patients.

There are many factors at play here, and none that can be resolved immediately, although some solutions may be simpler than you think. Some hospitals may be wrestling with:

  • An absence of clear clinical leadership and support for a more junior workforce that is reduced in numbers
  • Ineffective teamwork between clinicians who are rotated frequently and are geographically disparate
  • Reduced or no availability of on-site senior clinicians to assist with decisions that help manage patient complexity and acuity on general wards
  • Fragmented care for patients at risk of, or experiencing, clinical deterioration, largely due to a frequently rotating after-hours workforce that is further perpetuated by inconsistent clinical handover processes
  • A lack of governance that is responsive to the unique clinical and systems issues relevant to after-hours care.

It’s no surprise that clinicians can be negatively impacted by these factors. Sentiments commonly cited are that this type of working environment is ‘overwhelming’ and ‘exhausting.’

In light of these challenges, solutions have been developed and applied with varying degrees of success. Improving access to clinical resources, including clinical handover guides and common call resources has made a difference, just as clarification of roles, responsibilities, escalation strategies, and strengthened governance.

The old adage that necessity is the mother of invention can be applied here because technology offers a ready solution. Capitalising on the advantages offered by mobile first digital technology, hospitals are making timely access to critical resources much simpler. 

How Med App can help with after hours care

Since launching our dedicated After Hours resources section, which is located in the top left corner when the app is opened, hospital administration staff have found it easy to populate with the right information clinicians need to do their job more efficiently and effectively.

The flexibility and functionality within Med App allows hospitals to add their after hours survival guides, documented escalation strategies, and rosters.

Our three month data (refer to graph below) shows regular and consistent page views from all sites using this function, which is a strong indicator that not only do  clinicians require these resources, but are accessing them on an almost daily basis.  

Figure 1: Various Med App sites (represented by different colours) with a populated After Hours section have regular and consistent page views. Peak denotes new clinician onboarding. 

Hospitals that recognise the impact of a poorly resourced frontline workforce can take meaningful steps towards change via a quality improvement campaign with a focus on making enhancements to after hours care and support.

Med App facilitates tangible results from targeted communication and information sharing, making a compelling case for innovative technology that addresses many of the challenges mentioned above.

Although bringing about sustainable change in hospitals is notoriously arduous, the simplicity of being able to populate Med App easily with relevant, concise, and up to date information shifts the goal posts for organisational improvement initiatives. 

With that in mind, perhaps now is the ideal time to get involved and become part of the change you wish to see in your organisation, and your own after hours care project would be a good place to start.

Med App is an offline-accessible, mobile-first tool. It is ideal for the hospital environment where there is a high need for clinicians to access clinical and hospital guidelines easily, including after hours. Med App has been designed by clinicians for clinicians, and continues to innovate and improve the experience of frontline health workers and the patients to whom they deliver care. For more information, reach out by connecting with Dr Sonia Chanchliani via email at CMO@med.app, or uncover the possibilities when you book a complimentary Med App demonstration for your hospital.


References

  1. Lynn A. Pauls, BS, Rebecca Johnson-Paben, BS, John McGready, PhD, Jamie D. Murphy, MD, Pronovost PJ, Christopher L. Wu, MD, The Weekend Effect in Hospitalized Patients: A Meta-Analysis. J. Hosp. Med 2017;9;760-766. doi:10.12788/jhm.2815 10.12788/jhm
  2. Chen, Yen-Fu, et al. “Magnitude and modifiers of the weekend effect in hospital admissions: a systematic review and meta-analysis.” BMJ open 9.6 (2019): e025764.
  3. Kevat, Dev AS, et al. “Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis.” The Medical Journal of Australia194.11 (2011): 616.
  4. Sivey, P. Hospital patients are more likely to die at weekends but seven-day rosters are no panacea. The Conversation, https://theconversation.com/hospital-patients-are-more-likely-to-die-at-weekends-but-seven-day-rosters-are-no-panacea-45293 (Accessed March 2021)

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