1746P - Unintended consequences: Working time directives and oncology staff implications

Background

On-call work is an inherent component of Oncology care. Managerial models focus on length of stay in calculating efficiency within hospitals. Ensuring compliance with the European Working Time Directives (EWTD) for doctors is a legal requirement for Hospitals. Calculations of required physician staff to provide overnight care is not necessarily based on numbers of patients to be cared for, nor the complexity of care. The acute oncology service (AOS) after-hours has to date been provided by the day-time medical team in whole. To improve safety and quality of the AOS for patients being seen after hours, as well as to comply with the EWTD, a change to shift-work for the 1st-on-call oncology doctor is planned in 7/23. We sought to quantify the impact on the service.

Methods

The numbers of non-consultant hospital doctors (NCHDs), with allowances for full staff and also allowing for annual and educational leave entitlements were gathered for 1) pre-shift work implementation and 2) post-implementation of shift work. The number of NCHDs multiplied by the hours available to the ambulatory services (day unit and outpatient clinics) were calculated per week for both service structures to produce the "available NCHD hours".

Results

Assuming the normal working day is 8am to 5pm, this change would result in the reduction of available NCHDs to the ambulatory oncology service from 270 available NCHD hours per week to 171 available NCHD hours once vacation and study leave are factored into the equation, despite the addition of one NCHD to the medical oncology team. This represents a 36% reduction in available staff yet with a likely continued increase in patient activity.

Conclusions

While modifying the after-hours service to shift-work augments availability of medical staff for the acutely unwell patient with cancer and achieves compliance with EWTD, it reduces the numbers of doctors available for a significant part of the day, placing more strain on those doctors trying to manage a similar number of patients in a safe and patient-focused manner. Changes to the after-hours service inadvertently has knock-on effects on the “Oncology Ecosystem” and may impact on future service quality. Adjustments to NCHD numbers to cover the predicted significant staff fall short of those required.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Beaumont RCSI Cancer Centre.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.