EWTD hitting patient safety

Publication date:  22 окт 2009

A survey from the Royal College of Surgeons portrays a bleak picture of the impact of the 48 hour week on patient safety.

Services are only being held together by a “grey market” of doctors willing to covertly break the legislation to maintain care for patients, the college says. And the architects of more than 100 hospital rotas have applied to break the legislation, in addition to those already seeking approval to do so.

More than 360 consultant surgeons and more than 500 trainees responded to the survey. It showed that:

  • 64% of all respondents thought quality of care had worsened as a result of the restrictions

  • More than half of the responding consultants believed that compliance with the European Working Time Directive had been achieved at the expense of patient safety

  • A third of all respondents said that handover arrangements were inadequate in their hospital

  • 23% of respondents said they could not stay involved in all stages of clinical care that required their expertise

  • 62% of surgeons said they were not working a truly compliant 48 hour week, 70% of whom estimated they worked on average between 55 and 60 hours a week

  • A quarter of respondents said other professionals in the healthcare team were covering tasks previously done by surgeons

  • 43% of respondents said they were covering rota gaps in other areas of their own hospital to keep services running.

“Patient care is being made significantly less safe through systems that lead to poor continuity of care, the loss of teams, and ‘wildcat’ closure of services,” said John Black, president of the Royal College of Surgeons.

“We now have the ridiculous situation where the Department of Health in public moralises over fears that trainees are being coerced into working over 48 hours while privately relying on these doctors to stay longer or cover additional dead end shifts as locums because there is no way the service could keep running otherwise.”

He said that patients were at increased risk of dying as a direct result of so many shift changeovers and that trainee surgeons were staying on unpaid after the hours limit because they want to see through care for their patients.

Trainees were also taking on additional paid locum work in the hope of gaining the training opportunities that they couldn’t get in their formal working week.

Cite this as BMJ Careers ; doi: