Junior doctors' work at night: what is done and how much is appropriate?

Regional task forces have given some public health physicians a central role in attempts to reduce junior doctors' hours. This topic is the subject of many diverse opinions and little research. A key issue that has received little attention is the appropriateness of the work undertaken by junior doctors at night. This paper determines whether this work can either be postponed to the following morning or done by someone else. It was undertaken in two phases: a descriptive study using diaries, interviews and collection of data from registers; and identification of consensus on appropriateness of activities by a nominal group technique. The first phase took place in hospitals in the South East of England. The nominal groups consisted of six panels comprising medical, nursing and laboratory scientific staff. The panels identified activities done at night that can either be postponed to the following day or done by someone else and activities where there is disagreement, requiring further research. A third of general surgical and orthopaedic operations could safely be postponed until the following day. Up to a third of the tasks of house officers could be performed by nursing or clerical staff. Many laboratory investigations at night could be postponed until the following day. In conclusion, the work of junior doctors at night could be reduced by producing guidelines on the need to operate at night, by transferring tasks to other professionals, and by reducing the number of sites at which services are provided.