Joanna Moorhead 

Are new hospital shift patterns putting you in danger?

Changes to the shift system for hospital staff could pose a risk to patients, says Joanna Moorhead
  
  

A doctor with clipboard
The new 48-hour working week for hospital staff means you might not see the right doctor. Photograph: Getty Images Photograph: Getty Images

Communication breakdowns between doctors, says the Royal College of Surgeons in a report this week, can be bad for your health. Disastrous, in fact, and it even lists cases where patients have died following too many shift changes, flipping between doctors because of new EU rules that impose a 48-hour week on hospital staff.

It's worrying stuff. In a perfect world medics would be clued up on every nuance of a patient's condition – but we're talking the imperfect world of the NHS, where it's not unheard of for people to have operations they were never meant to have, for tests not to be carried out or the results never reported back, and for in-patients to get "lost" in the system.

So what can you do, as a patient, to minimise the chances of getting wheeled into the wrong operating theatre or jabbed with the wrong needle? If medical staff are failing to communicate effectively, the buck rests with you – it's not enough to think "I'm in hospital; they'll save me."

Ben Cresswell has just finished his training as a liver surgeon at London's Royal Free hospital, and he's convinced that a bit of patient know-how can be crucial. "It's mostly knowing what to ask," he says. "For example, if you, or someone in your family, is admitted to hospital as an emergency, you might think that the junior doctor who comes to assess your case is a specialist in whatever problem you seem to be suffering from. Well, this definitely isn't the case. You might be in with suspected appendicitis, for example, but the doctor standing at the end of your bed looking through your notes is training to be an orthopaedic surgeon and quite possibly only knows about appendicitis from a textbook.

"That's because, due to the new EU directive, fewer specialists are now on-call in hospitals. So you need to ask: are you a specialist in the right area of medicine for what I seem to have wrong with me? And if not, you have to make sure they call someone in. Because if not then the messages may be wrong right down the line as a result."

But it's once you're on the ward that the biggest mistakes can happen. Handovers are often very far short of ideal, reveals Cresswell. "They're sometimes described as Chinese whispers, and that's often not far short of the truth. If someone arrived at my bed who I'd not seen before I'd want to go through my history with them and make sure they knew my diagnosis or my working diagnosis. It's not uncommon for a doctor to arrive at a patient's bed without the faintest idea of what they're in hospital for."

'The devil is in the detail'

Of course there are always notes – but the problem, Cresswell explains, is that "the devil is in the detail. If you've not been following a patient's case, you might miss something small that's actually very significant." Which is why it's vital to speak up – better to tell the doctor something he already knows, than to risk him not knowing it at all.

That's all very well if you're fit enough to do it – what about people who are not? "It's very tricky," says Katherine Murphy, director of the Patients' Association. "Elderly people make up the biggest hospital population, and they're often unable to recall or to communicate the important details of their illness.

"I suggest to relatives that they put up a notice near the bed with the most important information, in a place that every doctor and nurse will notice. All crucial information – about allergies, for example – should be written in red on the cover of a patient's notes, so if there's a vital bit of information that you're concerned about, check with ward staff that that's been done."

Being admitted for planned surgery has its pitfalls too. "There's a tendency these days for patients to be given pre-op checks at a pre-admission clinic which may be a week or two ahead of the operation," says Cresswell. "But the doctor you see at that clinic may be nothing to do with the team in whose care you will be when you're admitted. I'd always ask whether the doctor who sees you at that clinic is a member of the relevant team, and if not, ask to be transferred to a member of that team."

 

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