Baseline report highlights benefits of Hospital at Night

Almost half of NHS trusts in England have adopted the Hospital at Night method of team working and are seeing clear benefits from the new system providing care at night according to a new survey.

As well as providing new opportunities and enhanced roles for nursing staff, some hospital trusts using the model are reporting a reduction in clinical incidents. However, the report also states that trusts need to provide clear senior leadership and provide the initial financial investment to develop Hospital at Night in order to see the patient benefit and longer term productivity and efficiency rewards that it can provide. Trusts also need to see it as a key part of work in the move towards compliance with the WTD 2009 with the opportunity to develop new roles as junior doctor working hours reduce to a maximum of 48 per week.

The Hospital at Night Baseline Report assessed the impact of the model across the NHS and looked at how trusts were adopting or using the multi-professional approach. It is the first major assessment of progress since Hospital at Night was introduced in 2004. A survey was carried out in the summer saw responses from 97 trusts. The report findings give an overview of Hospital at Night across the country and identifies recommendations for trusts who have Hospital at Night teams in place, are considering adopting the model or who are looking for solutions to WTD 2009 workforce issues.

The survey asked a total of 58 questions relating to nine enablers of Hospital at Night which include aspects such as clinical leadership, handover, clinical audit, training and clinical and risk governance.

Key findings are that:

• 88% of trusts have implemented or are implementing Hospital at Night – 48% have a team in place and 40% are planning to put a team in place
• Trusts who are successfully implementing Hospital at Night are doing so because of support from executive directors, clinical leadership and dedicated project management time
• 93% of trusts successfully implementing the model have a medical or clinical director championing Hospital at Night
• Handover is being built in with 75% of trusts having a handover policy drafted or in place
• It supports the delivery of WTD which underpins a range of other service delivery priorities and must be considered as part of the wider picture
• Senior leadership is essential - there needs to be a board level lead and regular board level reporting on the WTD and associated work. Such programmes should be linked rather than working in isolation
• It is clearly linked to the Modernising Medical Careers programme; all doctors exiting the foundation programme should be able to be competent members of the Hospital at Night team.

Key challenges to the implementation of Hospital at Night that trusts have reported include:

• Financial constraints in some NHS trusts have prevented full implementation of Hospital at Night - even though the survey shows that the model can have longer term financial benefits through more efficient team working
• Handover remains a complex area for some trusts to implement. It can be difficult getting all the team members to attend handover. Although there are examples of best practice using electronic systems that support handover it can be difficult to secure resources to introduce them.

Good practice examples that trusts highlighted in the report included reduction in the number of critical clinical incidents, wireless technology being adopted to support allocation of tasks and linkage of student nurse placements to the Hospital at Night team. Several trusts highlighted good practice in their handover with electronic nursing handover systems being developed and nurse clinicians leading the handover.

The full report and further information on Hospital at Night is available at www.hospitalatnight.nhs.uk.