3 x 9 hour shift pattern

University Hospitals Coventry & Warwickshire (UHCW) NHS Trust in Coventry piloted the study on its Acute Medical Rota. All doctors in this study were Senior House Officers (SHOs). This large progressive NHS trust was chosen for the complexity of the rota systems which involve many different medical sub-specialities. The cell size of 9 doctors on the rota was achieved by combining an acute medicine cell of 5 doctors with the cell of 4 doctors in endocrinology. As smaller trusts may have difficulty constructing rota cells larger than 9, the findings of this study will be more generally applicable than the recommended cell size of 10 doctors.

Challenges

The study compared the medical SHO rota at UHCW on two different rotas. Rota A was an adaptation of the current rota, where junior doctors work 54 hour weeks with blocks of three and four 12.5 hour night shifts in succession. Rota B was the new schedule where 9 doctors work a rota which has been adapted to a 48 hour week with blocks of three nine-hour night shifts, and only occasionally work two nights in succession. This study looked at four parameters on which the rota change is expected to have beneficial impact.

• Patient safety
• Doctors' rest and sleep
• Doctors' quality of life
• Quality of handover information

Delivering compliance

The 3x9 hour shift using a cell size of 9 doctors aimed to demonstrate that it is possible to reduce the workload of doctors in training and equivalent grades to be WTD 2009 compliant. The benefits of this study are an improvement in patient safety i.e. 33% fewer clinical incidents and a reduction in doctors’ fatigue. The pilot started in March 2007 and completed in November 2007. The findings of the study were published in March 2008 in the Quarterly Journal of Medicine.