Abstract
Recent government plans include the concept of a core of doctors of intermediate grade providing 24 hour emergency cover in hospital departments. Hinchingbrooke Hospital has, since its opening in 1983, been run on a two tier basis, with consultants and a part time senior registrar supported only by senior house officers in their first post, usually on general practice vocational training schemes. With a planned rate of around 2000 deliveries per year all high risk obstetric and neonatal paediatric procedures, including ventilation of very small babies, have been carried out within the hospital. A study of the first five complete years of operation of the obstetric and paediatric departments showed that the perinatal mortality rate was low (hospital rate 4.7/1000 in 9149 deliveries during 1984-8 v district rate 5.1/1000 during 1986-8), and patient satisfaction seemed to be high. In a separate prospective study of out of hours work performed by consultants in paediatrics (four weeks) and obstetrics (20 days) three consultants in paediatrics spent 71 hours working out of hours; for the obstetricians, of the 56 request for advice and 38 interventions, only five and six respectively occurred between midnight and 9 am. Although successful at this hospital, the two tier system would be expensive under the Royal College of Obstetricians' guidelines of one consultant to a maximum of 500 deliveries. An equal mixture of two tier and three tier systems might be the best solution for patient care and training of junior doctors.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Beverley D., Foote K., Howel D., Congdon P. Effect of birthplace on infants with low birth weight. Br Med J (Clin Res Ed) 1986 Oct 18;293(6553):981–983. doi: 10.1136/bmj.293.6553.981. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Coupland V. A., Green J. M., Kitzinger J. V., Richards M. P. Obstetricians on the labour ward: implications of medical staffing structures. Br Med J (Clin Res Ed) 1987 Oct 24;295(6605):1077–1079. doi: 10.1136/bmj.295.6605.1077. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Davies M. G., Kersey P. J. Acute hepatitis and exfoliative dermatitis associated with minocycline. BMJ. 1989 Jun 3;298(6686):1523–1524. doi: 10.1136/bmj.298.6686.1523-c. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marlow N., Chiswick M. L. Neurodevelopmental outcome of babies weighing less than 2001 g at birth: influence of perinatal transfer and mechanical ventilation. Arch Dis Child. 1988 Sep;63(9):1069–1074. doi: 10.1136/adc.63.9.1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marlow N., Hunt L. P., Chiswick M. L. Clinical factors associated with adverse outcome for babies weighing 2000 g or less at birth. Arch Dis Child. 1988 Oct;63(10 Spec No):1131–1136. doi: 10.1136/adc.63.10_spec_no.1131. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Powell T. G., Pharoah P. O., Cooke R. W. Survival and morbidity in a geographically defined population of low birthweight infants. Lancet. 1986 Mar 8;1(8480):539–543. doi: 10.1016/s0140-6736(86)90893-7. [DOI] [PubMed] [Google Scholar]
- Sandhu B., Stevenson R. C., Cooke R. W., Pharoah P. O. Cost of neonatal intensive care for very-low-birthweight infants. Lancet. 1986 Mar 15;1(8481):600–603. doi: 10.1016/s0140-6736(86)92820-5. [DOI] [PubMed] [Google Scholar]
- Wariyar U., Richmond S., Hey E. Pregnancy outcome at 24-31 weeks' gestation: neonatal survivors. Arch Dis Child. 1989 May;64(5):678–686. doi: 10.1136/adc.64.5.678. [DOI] [PMC free article] [PubMed] [Google Scholar]