ICU Senior Registrars join the Alfred Hospital’s Night-Time Team

As part of the Timely Quality Care (TQC) project in the Alfred Hospital, there have been recent changes to the night-time team.  Central to this has been the introduction of a new overnight senior medical role; the Hospital Clinical Lead (CL).  This additional post is staffed by the Senior Registrars in Intensive Care, who will rotate through the job throughout the year.

The Hospital Clinical Lead commenced in February with the changeover of Junior Medical Staff.  The role is designed to progress the care of patients who attend the Alfred Hospital from the moment they are admitted; and to improve the quality of their subsequent care overnight.

Staffing in acute hospitals at night has become a persistent problem, with increasing numbers of admissions and limited time spent in the Emergency Department.  This care is delivered by a range of specialties and grades, often overstretched and working as a collection of individuals rather than a coherent after-hours team.  In addition Junior Medical staff working at night (often in 3 month blocks) find that they receive little or no feedback on their performance or decision-making.

With this in mind the CL was established with a vision to improve the entire process of medical care after-hours by developing the after-hours team and providing clinical leadership within the hospital, broadly covering the following:

  • State of the hospital

The CL has a broad overview of the hospital at night by determining the areas of pressure within the hospital including bed-state, patients waiting admission, unstable patients and demand for monitored beds.

  • Handover

There is now a formalised handover process led by the CL and attended by the medical staff overnight as well as two new nursing positions, the Clinical Operations manager and the Patient Flow Coordinator.   As a result the team can raise concerns that can be acted on immediately and co-operate to help colleagues who are under pressure from a heavy workload.  The handover is repeated later in the night with follow-up on issues raised earlier and plans for the rest of the night.

  • Ongoing clinical care

The CL is informed of all admissions, MET calls and patients meeting Clinical Review Criteria.  This fulfils a dual purpose, providing immediate feedback to the treating physician and improving the quality of care provided at the bedside throughout the night.

  • Workload distribution

With the variable nature of hospital work load, there may be times when some doctors have a long list of tasks still to complete and others are free.  This means that in some cases, patient care may be delayed.  The CL liaises closely with all staff throughout the night and re-distributes tasks so that overall patient care is carried out in a timely fashion.  This will shortly improve with the introduction of an electronic task management system, which will be managed by the CL.

  • Education and supervision

Teaching now takes place both informally throughout the night, and also as a team discussing interesting or challenging cases we have encountered.  The CLs provide supervision for more complex procedures and formal appraisal for staff who have been working their three-month ‘block’ of nights.

In conjunction with the new role, the Alfred ICU has commenced a training course in Clinical Leadership and Mentoring for the Senior Registrars that is run throughout the year.  This is designed to equip both for the CL role and build on the experiences gained for their future careers as clinical leaders and mentors.

Our early impressions are that the new role is a success. We have been overwhelmed by the positive feedback from junior doctors and allied health professionals, as well as unconditional support from on call specialists, who receive far fewer after hours calls, yet are confident that the care in the hospital is of high quality.






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