Psychiatry after-hours: factors impacting workload and workflow

Abstract

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but had less confidence in other key clinicians. Many registrars did not discuss after-hours work during supervision. Conclusions: The after-hours experience of psychiatry registrars at a university hospital is arduous and includes a wide range of clinical tasks. This activity is an essential service provision undertaking as well as a training activity. This must be weighed against the impact of after-hours work on registrar well-being.