Thursday, 5 February 2009

BMJ praises Hospital at Night

The BMJ is a pretty ropey journal and if we're honest it wouldn't really be read by many people unless it was dished out free with membership of the BMA. Then if we're honest the BMA wouldn't be very popular if doctors had a decent union (that instead of trying to gain itself knighthoods and peerages for itself) that bothered to try to represent the interests of front line doctors.

The BMJ has recently come up with a load of awards in categories from 'Best Research Paper' to 'Excellence in Learning and Education', the full list of nominations can be viewed here. There are some very worthy nominations there, for example Ben Goldacre in the snazzily named category 'Health Communicator of the year'. However there are unsurprisingly some rather pathetic nominations that seem to have been done in a rather typical 'politically pleasing' manner. The nomination for the Hospital at Night team beggars belief and is factually incorrect for starters:

"Hospital at Night team: Skills for Health - Workforce Projects Team
The Hospital at Night (HaN) programme is a clinically driven and patient focused change programme which uses both a multiprofessional and multi-speciality approach to delivering care at night and out of hours. The programme enhances patient safety and outcomes and supports medical training and service delivery. The benefits of utilising HaN to training are:

  • Exposure to the key management skills for early detection, management and support for acutely ill patients out of hours in a multiprofessional approach
  • Enhanced utilisation of team competences
  • Escalation of clinical issues with supervision and support from senior clinical staff
  • Develops the capacity to deliver the junior doctor foundation programme curriculum.

They have conducted a comprehensive analysis of this project."

Interestingly the problems associated with the low staffing levels at night times in hospitals are not the fault of Hospital at Night (HaN), they are the fault of shift working and the EWTD which have resulted in hospitals being left dangerously short staffed with a real lack of continuity of care for patients. HaN is the government spin being used to paper over these gaping cracks.

HaN claimed it improved patients outcomes when it was first introduced, despite having no evidence that it did, it even wrote in big letters on its website 'better care'. Even recently the evidence on outcomes that it has is scanty at best and this evidence appears to have been misrepresented rather cynically by the HaN team.

The only report that has measured patient outcomes following HaN introduction is methodologically flawed and shows no results to back up the HaN teams claims, there were no statistically proven improvements following HaN's introduction. In fact there was an increase in 'the actual number of deaths' following HaN, however this is written off as being because of increased patient numbers, there are other explanations that they have not considered however.

The spin from the BMJ and the HaN makes it appear that all is wonderful thanks to the HaN scheme, despite the lack of any decent evidence to back these claims up, at best HaN has made no difference to outcomes or safety. Anecdotally if you speak to any doctors on the ground you will hear horror stories of nurses being empowered beyond their means, staffing levels that are dangerously low, doctors working outside their areas of expertise due to this short staffing and patients dying as a result of all this.

It's great that the BMJ are recognising these achievements of the HaN team, it speaks volumes for the way in which statistically insignificant evidence published on a government website can be spun in such a dishonest and irresponsible manner. Well done HaN team, I hope you're proud.

18 comments:

MrAngryman said...

sounds like my hospital! The HaN team is staffed by ex orthopaedic nurse's who its fair to say the only reason they were employed is because they could work nights! None of them are from 'acute' backgrounds (i.e medical admissions, A+E, ITU) so you are having patients reviewed by nurse's who are clinically incapable of making those decisions. Still at least it saves the government some money.

Anonymous said...

So, you bemoan the fact that H@N make claimes without any statistics to back them up, then you state "at best H@N has made no difference to outcomes or safety"!! You appear to have ommitted those all important statistics to back this up. Hilarious. So are you the pot, or the kettle?

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