Psychiatry after-hours: factors impacting workload and workflow

Area of Science:

• Medical Education
• Psychiatry Workforce Research
• Healthcare Management

Background:

• After-hours shifts are crucial for psychiatric service provision and registrar training.
• Understanding the demands on registrars during these shifts is essential for optimizing healthcare delivery and training.

Purpose of the Study:

• To evaluate the workload and workflow of psychiatry registrars on after-hours rosters.
• To quantify registrar perceptions of their after-hours experience.
• To provide recommendations for system redesign to improve the after-hours service and training.

Main Methods:

• Utilized multiple data sources, including medical student observers and telephone logs, to quantify tasks.
• Administered a satisfaction questionnaire to registrars to assess their perceptions.
• Analyzed shift data to identify patterns in workload and workflow.

Main Results:

• After-hours shifts involved a significant and complex workload, including emergency reviews, ward consultations, and admissions.
• Workflow interruptions were frequent, with a high volume of phone calls and critical incidents noted.
• Registrars reported confidence in their own abilities but less confidence in other clinicians, and often did not discuss after-hours work during supervision.

Conclusions:

• The after-hours experience for psychiatry registrars is demanding, encompassing diverse clinical tasks.
• After-hours work serves as both essential service provision and a critical training component.
• The impact of after-hours work on registrar well-being must be carefully considered in system design and management.