Hip fracture documentation-the impact of shift systems

The recent reduction in junior doctors' hours has lead to a change in working patterns. The aim of this study was to assess the effect of this change on documentation in orthopaedic surgery. Over a 6-week period, 25 patients were admitted to our unit with hip fractures. During this period, all junior doctors worked on a 'full-shift' working pattern. For comparison a control group was formed comprising of 29 patients admitted with hip fractures over an earlier 6 weeks when all junior doctors worked on a traditional 'on-call' system. The medical records of each patient were assessed for the quality of medical documentation using a published scoring system. The on-call group scored higher for the standard of documentation compared with the shift system group (mean 24.8 versus mean 21.3), p<0.05. The on-call group also had fewer weekdays without any documented entries in the medical records compared to the shift system group (mean 3.2 days versus mean 4.0 days), p<0.05. A change in the working pattern for junior doctors has lead to a reduction in the quality of medical documentation. With more personnel working fewer hours, maintaining a high standard of documentation is essential for the good clinical care of patients.