Covering the cardiac ICU at night: a national survey of existing levels of cover and the potential for change with implementation of the European working time directive

Introduction

During 2009 the European working time directive (EWTD) requires trainee doctors to work an average 48-hour week [1]. Hospitals will be seeking novel methods to cover existing medical rotas. We aimed to establish whether it would be reasonable to reduce current levels of out-of-hours (OOH) medical cover in cardiac ICUs (CICUs) based upon current UK practice.

Methods

All UK units caring for cardiac surgical patients were contacted in January 2008. OOH medical cover was ascertained by speaking to either a consultant or a senior nurse. The 30-day survival rate and annual caseload for all cardiac surgery over a 3-year period up to March 2006 were analysed [2].

Results

Thirty-nine CICUs were contacted. Three were excluded because of incomplete data. OOH anaesthetic specialist registrar (ASpR) cover for CICUs is presented in Table 1. The 30-day survival rate for cardiac surgery over a 3-year period ending March 2006 was either the same as or higher than expected based on predictive EuroSCORE data for all units. One centre performing <1,000 cases per year employed a nurse practitioner trained in intubation and central venous cannulation rather than having a dedicated ASpR.

Table 1 Anaesthetic cover for UK CICUs outside normal working hours

Conclusion

Units undertaking >1,000 cases per year have dedicated OOH ASpR cover. EuroSCOREs are increasing amongst UK cardiac surgical patients because of increasing age, and this leads to lower predicted survival [3]. A reduction in medical cover on CICUs to facilitate implementation of the EWTD would be counterintuitive and outside current UK practice for units performing >1,000 cases per year. Novel models exist but more work is required to establish their safety in larger units.