Casualty surgeons start 24-hour shifts

TRAUMA surgeons in Oxford today start working 24-hour shifts to cover emergencies in a move that could become a model for casualty services.

Under the system, four full- time and three part-time consultants will work an 8am to 8am 'day' with at least 24 hours and sometimes 48 hours off afterwards. The doctors involved believe the move will improve the quality of patient care while ensuring that junior doctors' hours can be cut.

Mr Keith Willett, director of trauma services at the Churchill John Radcliffe hospital, said studies showed that at least 20 per cent of deaths from multiple injuries were unnecessary, while one in five of those with isolated limb injuries suffered avoidable disability. This was mainly because inadequate treatment was provided by relatively inexperienced doctors operating outside the normal working day.

'Under this system, if you are seriously injured at 2am you won't get an inexperienced junior doctor but a consultant- led trauma team. The most important time for the patient is immediately after arrival - if you get the resuscitation, assessment and the first operation right, you very rarely get complications.'

The switch to a consultant- based service has been driven by the 'quality of care' issue, Mr Willett said, and the requirement to cut junior doctors' hours.

It is being carefully monitored for its impact on both patients and doctors, but Mr Willett said other frontline specialities such as anaesthetics, obstetrics and paediatrics will also need to consider such changes. 'It is a big culture shock for the service . . . consultants have not worked in this way before.'

The scheme has been made possible by pounds 50,000 for an extra consultant from the Government scheme to cut juniors' hours and similar savings from within the pounds 5m trauma budget at the hospital.