Out-of-hours workload of junior and senior house surgeons in a district general hospital.

The objective of this study was to assess the out-of-hours workload of junior and senior house officers in general surgery working in a busy DGH in relation to the 'New Deal' guidelines on junior doctors' hours of work. We also wanted to identify safe levels of manning for these grades of staff and to collect accurate data on workload upon which decisions could be made regarding any change in manning levels consequent upon the 'New Deal'. The study is a prospective audit of all work undertaken by 11 junior and senior house surgeons attached to six consultants between 1700 hrs and 0800 hrs during a 16-day period in August 1992. The results showed that the out-of-hours workload of the five JHOs and six SHOs proved to be very onerous. The rotas were 1:5 or 1:6 for emergencies depending on grade plus 1:11 for ward cover. The JHOs were occupied for 70 per cent of the period between 1700 hrs and 2400 hrs and 32.5 per cent of the period after 2400 hrs. For the same periods the SHOs were busy for 61 per cent and 29 per cent respectively. The doctors covering ward duties were occupied for 48 per cent of the period up to midnight when the duty period ended. Both grades got four hours sleep on five of 16 nights. Non-medical tasks accounted for 29 per cent of the ward doctors working time but were a small part of the other doctors work. It was concluded that in this typical busy DGH junior and senior house officers work extremely hard when on call, and that they cannot be reasonably be asked to further increase their level of activity. It follows that a reduction in the hours of work will require additional staff if the standard of care delivered to the patients is to be maintained.