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Psychiatry at night: experience of the senior house officer

Prospect Park Hospital, Newbury CMHT, Beechcroft, Hillcroft House, Rooke’s Way, Off Turnpike Road, Thatcham, Berkshire, RG18 3HR, email: jules.mason{at}berkshire.nhs.uk

Tina Irani, Senior House Officer in Psychiatry

Oxford Deanery Rotation, Oxford

Garyfallia Fountoulaki, Specialist Registrar in Psychiatry

Oxford Deanery Rotation, Oxford

Sylvia Warwick, Clinical Audit and Research Manager

Berkshire Health Care NHS Trust, Berkshire

Jane Da Roza Davis, Consultant Psychiatrist

Prospect Park Hospital, Berkshire

Peter Sudbury, Medical Director

Berkshire Health Care NHS Trust, Berkshire

Declaration of interest

None.

AIMS AND METHOD

We gathered detailed prospective data for first on-call activity of senior house officers (SHOs) in order to help plan changes in service provision so that SHOs in psychiatry complied with the Working Time Directive and to determine whether service changes affected training experience while on call. The incumbent SHOs designed a simple form to monitor on-call activity in West Berkshire.

RESULTS

Admissions and assessments make up a quarter of calls but three-quarters of the work. An overnight crisis service reduced the number of assessments made by SHOs out of hours by 68%. Screening of calls by a senior nurse reduced the number of calls about in-patients by 60% on weekday nights. Between 73% and 100% of calls about in-patients after midnight were for assessment of patients in seclusion and rapid tranquillisation.

CLINICAL IMPLICATIONS

This survey helped to plan service delivery and to monitor the training of SHOs during on call. Screening of calls by a senior nurse, alternatives to seclusion and nurse-led prescribing for rapid tranquillisation would have the largest impact on the work generated by in-patients. The overnight crisis service reduced the number of assessments, but might have an adverse impact on training.

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