Having a consultant paediatrician on site could lead to a small but significant reduction in acute paediatric admissions, suggests a study published in Archives of Disease in Childhood.
The study reviewed duty rotas between February 2007 and June 2017 for the 24-hour, seven-day acute paediatric service at Salisbury District Hospital. Each night (Monday-Sunday 21:00-09:00) and weekend day (Saturday and Sunday 09:00-21:00) shift was identified as resident consultant or non-resident consultant. Resident consultant required that the consultant stayed on site for the entire duration of the shift.
Admission numbers (duration of stay of ≥four hours) were obtained from hospital activity databases. Analyses were undertaken on total admissions and stratified by time of day and duration of stay of >12 or
For all shifts, children were significantly more likely to be admitted on a non-resident consultant shift (incidence rate ratio [IRR], 1.07; 95% CI, 1.04-1.09; P=.0001).
When shifts were stratified by nights and weekend days and by short and long admission durations, the only significant effect was for short admissions at night (IRR, 1.09; 95% CI, 1.02-1.18). IRR for all nights was 1.03 (95% CI, 0.99-1.09) and for long-stay nights was 1.01 (95% CI, 0.96-1.07).
The IRR for all weekend days was 1.03 (95% CI, 0.99-1.18), whereas the ratio was 0.98 (95% CI, 0.94-1.03) for long weekend days and 1.07 (95% CI, 0.99-1.16) for long weekend nights.
The observation that no significant differences were seen for those who stayed more than 12 hours and were thus likely to have been more unwell suggests that the difference was largely explained by decisions made on less ill children.
The authors commented that an economic analysis might indicate whether the reduction in admissions could justify the extra costs of employing consultants out of hours, which was beyond the scope of this study.