Evaluation and results
A comprehensive evaluation strategy was undertaken with a pre-specified, mixed-methods protocol. External support was garnered from the health services research organisation AusHSI. Significant gains were made with respect to patient safety, in particular sustained improvements in the RBWH Hospital Diagnosis Sustained Mortality Ratio (86% pre / 75% post) with notable mortality risk reductions for Patient of Concern cohorts (inter hospital transfer and after hours admissions). Strong and sustained improvement in patient perceptions of after hours care were realised. Staff satisfaction and perceptions of after hours care also demonstrated improvements on repeated survey, with further supporting evidence in reduced unplanned leave and overtime for junior medical officers.
Lessons learnt
Numerous cultural barriers to enhanced senior medical presence after hours have been encountered and challenged over the course of the project, with pragmatic compromise reached to maximise outcomes for more junior staff and our patients. Necessity of expertise to measure outcomes of a complex intervention such as UP LATE and convey in a manner that can convince decision-makers of the value proposition. Multi-layered interventions that enhance capability of after hours clinicians broadly, e.g. educational initiatives, are an important driver of outcomes - not just the addition of further clinician numbers.
