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he standard of out-of-hours care is a huge area of concern

for the health service. Studies demonstrate drops in

healthcare quality at night and on weekends, including

significant increases in mortality. The demands of out-of-hours

working lower quality of life for staff and impact the costs of care

through absenteeism and over-reliance on locums. Despite well

documented effects, out-of-hours care remains under-studied, due

in part to practicalities of large scale manual studies in complex,

geographically dispersed, and sensitive working environments.

Dr Dominic Shaw is a clinical academic and leads out-of-hours care

at Nottingham City Hospital. He summarises the problem: “Providing

care 24 hours a day 7 days a week is a hugely complicated,

costly and specialist task. Understanding the relationship between

workload and work place will help our understanding of this vital


The Horizon Wayward project investigates the collection and analysis

of data concerning out-of-hours care in secondary care institutions.

Dr Michael Brown, a researcher on the project, comments: “As it

stands little is known about how doctors deliver out-of-hours care

in hospitals and even less about whether they are doing it right. This

is a problem Wayward is addressing head on though novel methods

and technologies.”

Wayward builds upon technology and procedures developed by

the team in order to identify best practice for out-of-hours training,

management and care delivery and make nationally relevant

recommendations. They utilise the relationship between activity

and location to record the type, timing and location of tasks being

undertaken by medical doctors without the need for traditional direct

observation methods.

In collaboration with three NHS Trusts (Nottingham University

Hospitals, Aintree Hospital and Blackpool Victoria Hospital) and

Liverpool School of Tropical Medicine the team has recently been

awarded funding from the Health Foundation for the uptake and

spread of the project team’s ground breaking data collection

technologies across NHS hospitals. “It will allow the expansion of our

studies over multiple sites in order to demonstrate that the methods

are scalable, cost effective and unobtrusive for staff and patients,”

Dr Shaw says. “It will enable evidence based improvements to safety,

efficiency, and efficacy in service provision for this understudied and

important aspect of secondary care.”

For further information, please contact:

Dr Michael Brown



Wayward: Informing best practice in out-of-hours secondary care