A Service Evaluation of Workload Monitoring for the Psychiatric Resident On-Call Rota

Abstract

Aims

The Psychiatric Resident On-Call (PROC) rota provides medical cover for all inpatients across Leeds and York Partnership NHS Foundation Trust outside normal working hours. With the introduction of a new regional inpatient CAMHS unit in August 2021, a service evaluation project was undertaken to establish if the current medical provision was sufficient to meet the increased demand of expanding services.

Methods

Workload monitoring was undertaken for 28 days during August and September 2022 for all evening, weekend, night and bank holiday shifts. Data collection documents in the form of Microsoft Excel spreadsheets were sent to one doctor to co-ordinate for all PROC doctors on each shift. For each 30-minute period, the number of doctors engaged in clinical activity was documented and the average number working at that time, as well as standard deviation, was calculated.

Results

51 out of 56 on-call shifts were accounted for during the workload monitoring period by returning of a completed data collection document. Workforce demand for the remaining five shifts was estimated from reviewing handover document with listed times of call-out and expected duration for each job.

Data showed that workload was consistent throughout weekend shifts, but slowed around the time of handover. This is likely due to the end of shift being used to complete documentation, and the start of shift being used to assign roles and plan the shift ahead. In addition, lengthy non-urgent tasks may not have been appropriate to undertake if a PROC was due to shortly end their shift.

Patterns of night-shift working suggested a steady demand during the early hours of the shift, but a reduction during early hours of the morning, with trough levels being observed between 04:00 and 05:00 in the morning. No significant differences were observed between evening and night shifts across weekdays or weekends.

Conclusion

Assessing the above data led the authors to conclude two changes to workforce provision which may increase efficiency of workload. The first was to implement a cross-over role which could bridge periods of handover and ensure that a medic is still available to respond to tasks despite the change in workforce around these times. The second was to rebalance allocated provisions so that less medics were on shift during early hours of the morning, when demand was lowest, and re-allocated to evenings or weekends where demand appeared to be greater.