Patients in hospital should be reviewed by a consultant at least once every 24 hours, including weekends and bank holidays, unless there are good reasons for them to not to have a daily review, an authoritative report out today has recommended.
The Academy of Medical Royal Colleges, which brings together 20 colleges and faculties, has today launched its report outlining its commitment to delivering high quality care to patients seven days a week.
The publication: ‘Seven Day Consultant Present Care’, recommends three key standards to ensure all patients receive high quality care led by a consultant regardless of the day of the week.
The report raises a series of areas for improvement and highlights that it is unacceptable to not provide consultant-led care at weekends if evidence suggests that this is best for patients.
Currently, the availability of consultants and equivalent senior doctors varies widely across locations and across different areas of medicine in the evenings and at weekends. The report calls for the NHS to ensure that appropriate resources and adequate numbers of consultants are provided to enable consultant-led care to be achieved, seven days a week.
In addition to this, mortality and complication rates are significantly higher for patients admitted as emergencies at the weekend. Patients admitted to a UK hospital at a weekend are more likely to die during their hospital stay than those admitted during weekdays.
The report demonstrates the high level of commitment among the medical Royal Colleges to see an improvement in the quality of care delivered to patients at weekends and after hours. It aims to ensure patients receive the best consultant-led care regardless of when they are admitted.
Three patient-centred standards to guide the delivery of consistent care irrespective of the day of the week are highlighted in the publication:
- Hospital inpatients should be reviewed by an on-site consultant at least once every 24 hours, seven days a week, unless it has been determined that this is not necessary for the patient
- Consultant-supervised interventions and investigations along with reports should be provided daily if the results will change the outcome or status of the patient’s overall care before the next ‘normal’ working day. This should include interventions which will enable immediate discharge or a shortened length of stay
- Support services both in hospitals and in the primary care community setting should be available daily to ensure that the next steps in the patient’s treatment, as determined by the daily consultant review, can be taken. It also acknowledges that it is outside its scope to look in detail at community services.
The report highlights that the Academy of Medical Royal Colleges does not see these standards as a panacea for all patient safety issues, but as a strong contribution to improving consistent quality care for patients.
Professor Norman Williams, Steering Group Chair and President of the Royal College of Surgeons of England, said:
"The standards we recommend in this report reflect the importance of daily consultant-led care and the support that needs to accompany this to ensure that patients receive the very best treatment. It cannot be right that over weekends and bank holidays, patients may receive a lower standard of care than they would during the week.
Clinical staff and managers must work together to re-shape hospital services in a way that strengthens the quality of care given to patients regardless of the time of day they are admitted. Similar arrangements will be necessary to support patients in the community when discharged at weekends. Ensuring that key staff are available to provide this support will come at a cost. However this is crucial for the full benefit of seven day consultant-led care to be realised."
Professor Terrence Stephenson, Chair of the Academy of Medical Royal Colleges, said:
"The evidence for the benefits of consultant delivered care is clear. We hope these standards will be supported and acted upon by the NHS Commissioning Authority so patients can receive the best care and treatment regardless of when they need it."