“On-Call” Tasks in the Paediatric Cardiology Unit - A Quality Improvement Project

Background: The national cardiology inpatient unit cares for some of the most complex and acutely unwell children in Ireland. Such patients have frequent alterations in clinical state necessitating frequent review and often have complex care plans and early warning score amendments in place. Oftentimes medical input to these patients on-call cannot be anticipated, however it was hypothesised that much of the task burden for house officers could be dealt with during, and is more appropriate to, routine hours and familiar team input to achieve improved quality patient care. Reducing time spent on routine tasks on-call also increases time available for direct patient care.

Aims: To examine the variation, content and quantity of tasks requested of the on-call house officer on the cardiology unit and to seek to improve the number of tasks which would be better served, and could be anticipated by medical input during routine hours.

Methods: The house officer on-call tasks were recorded on a specifically designed project sheet from a sample period in March and April 2017 and were analysed using Excel. The results were presented to the cardiology team in chart format and discussed as a continuous measure.

Results: The most frequent tasks involved charting and altering medications, in particular analgesia and amending early warning scores. A smaller proportion of these tasks necessitated medical reviews. As the study period progressed the number of routine tasks declined as these areas were brought to the attention to the primary team. Medical reviews remained stable throughout the period.

Conclusion: Awareness of the on-call tasks by the responsible team lead to an improvement in the number of avoidable routine tasks passing forward to-on call doctors while unanticipated review remained appropriately stable. This has favourable impact on time management and improving quality of patient care.