Impact of introducing consultant resident on-call in a district general hospital

Introduction of structured competency-based training for specialty registrars and implementation of European Working Time Directives (EWTD) have affected the quality of maternity care. 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. To examine the impact of introducing out-of-hours consultant resident on-call on maternity care, data from 486 deliveries including 59 CRO and 59 registrar shifts were collected retrospectively, from July 2010 to April 2011. Main outcome measures include mode of delivery, second-stage management, maternal and neonatal outcomes. Feedback from consultants, junior trainees and midwives on the impact of CRO were collated through semi-structured interviews. More normal vaginal deliveries (71.8% vs 63.0%) and fewer emergency caesarean sections (12.5% vs 20.6%) were performed in the CRO shifts compared with registrar on-call. Instrumental delivery rates in labour rooms vs theatre were higher when compared with the registrar group. Overall, good patient and staff experience was reflected during interviews. Our work shows that introduction of CRO in out-of-hours settings is acceptable among staff and is associated with fewer obstetric interventions. However, improved job descriptions may be needed in order to make the CRO post more attractive.