Out-of-hours calls in clinical microbiology: the when, the why and from whom

Microbiology services provided to hospitals must be delivered 24 h a day. In addition to during routine so-called 'office hours', clinical microbiologists have to provide an on-call service 7 days a week. However, there are few data on what that involves and how the service is delivered. I reviewed the source, reason for, grade of staff from whom the call came and the need for any follow-up, over an 11-year period using a pro-forma, that had been used to review data before this time period. Details were available for 90% of calls received, and data from 809 calls were analysed. The sources of calls were most commonly from medicine specialties [163/809 (20.1%)], neurosurgery (which is a national referral centre) [148/809 (18.3%)] and the intensive care unit [143/809 (17.7%)]. The number of calls received between 23.00 hours and 07.00 hours was 107 (13.2%). Just over half of calls, i.e. 440/809 (54.6%), were related to treatment; 247/809 (30.5%) were for advice on diagnosis; and 79/809 (9.8%) were related to infection prevention and control (IPC) issues. Registrars (a senior training grade) accounted for 492/809 (60.8%) of calls, and 64/809 (7.9%) came from nurses mainly related to IPC matters. Overall, 25.4% (206/809) of calls required follow-up the next day but this increased from 4.5% in 2013 to 67.6% in 2018. The nature of calls received by a clinical microbiologist out-of-hours is varied and may be increasing due to the complexity of case mix and changes in medical staffing. Professional and other organisations would do well to review such workload when deciding on staffing levels and service planning, given increasing public and patient expectations, and the trend towards the centralisation/consolidation of laboratory diagnostic services.