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Impact of introducing consultant resident on-call in a district general hospital
  1. JWY Tang,
  2. A Al-Dujaily,
  3. J Dwyer,
  4. U Rajesh
  1. York District Hospital, NHS, York, United Kingdom

Abstract

Introduction The introduction of structured competency based training for specialty registrar1 and implementation of EWTD2 have affected the quality of maternity care. Patient safety concerns and safer childbirth requirements has advocated a Consultant Delivered Obstetric Service.3 4 In York District Hospital, consultant resident on-call (CRO) without registrar cover was introduced in July 2010 to address the long-standing problem of middle-grade out-of-hours coverage.

Aim To examine the impact of introducing out-of-hours consultant resident on-call on maternity care

Method Data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively from July 2010 to April 2011 using labour ward delivery records. Results were analysed by Microsoft excel. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Furthermore, feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews.

Results A significant higher number of normal vaginal deliveries (71.8% versus 63.0%) and fewer emergency C-Sections (12.5% versus 20.6%) were performed in the CRO shifts compared to registrar on-call. The numbers of instrumental and unsuccessful trial of instrumental deliveries were similar in both groups. There was no significant difference in maternal and neonatal complications between the groups. Overall, good patient and staff experience was reflected during interviews.

Conclusions The introduction of CRO in out-of-hours settings is associated with a trend towards reduction in emergency C-Section rates. We conclude therefore, that CRO posts need to be made more acceptable and could pioneer this work pattern for new consultants in the next few years.

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