Do senior clinical positions rostered after-hours (and known as the UP LATE team) improve outcomes for patients, staff and the hospital?

The study is evaluating elements of a quality improvement project known as UP LATE. UP LATE is the introduction of a 7 day after-hours (1600-0800) service and includes the following elements: - Senior Clinical Leads namely Advanced Training Registrars and Nurse Navigators on every evening and night shift. Governance structure and operational workplans have been developed in consultation with key stakeholders to ensure integration with existing after-hours processes and resources. A full day orientation program including simulation scenarios, leadership, team building and technical skills has been developed for the new team. A part-time clinical director has been appointed to oversee and build and integrate the new service. - Additional meetings and opportunities for improved clinical handover of patients from shift to shift and between transitions of care. These aim to follow best practice clinical handover guidelines and local hospital policies. Roles and responsibilities in relation to clinical handover are documented and audit schedules to monitor compliance have been established. - Use of an electronic system (Task Manager) to request and manage ward task requests for the after-hours junior medical officers for better management of workloads and workload planning by senior clinicians and administrators. Fact sheets and training sessions have been rolled out to all junior medical officers and ward nursing staff. This is also supported by education videos on-line for easy access. Reporting capabilities are in place and a feedback loop to clinicians and home teams is being trialled. - Utilisation of a Patient of Concern strategy that enables identification of patient cohorts that are most at risk of clinical deterioration to trigger proactive clinical review by senior clinicians. The Patient of Concern strategy was developed from a literature review and benchmarking against other peer hospitals and then tailored to RBWH using local clinical experts. This strategy has been formally endorsed by the organisation and includes specific criteria to identify patients at most risk of deterioration, an education package to ensure staff are compliant with the identification and management of Patients of Concern, an electronic flagging system, online resources, reporting functions within Patient Flow Manager and a regular audit schedule.