'Hospital-At-Night' Expedites Review of Trauma Patients Without Affecting Outcome from Hip Fracture (Clinical FEATURE‪)‬

Introduction The Hospital at Night (H@N) programme was originally trialled in 2004 as a response to a reduction in UK junior doctors' hours in line with the European Working Time Directive (DH 2005a). It seeks to off-set this reduction by providing a centralised, multidisciplinary and multispecialty model of out-of-hours medical cover, congruent with the recent change to a medical shift pattern. Typical structures comprise a senior nurse practitioner (with an extended role incorporating patient assessment, prescribing and basic procedures) who receives, triages and delegates all requests for medical input across all specialties to the H@N team. This team is designed to possess the requisite skills for out of hours cover, and typically includes nurse practitioners, clinical support workers, and junior and senior medical staff. This is in contrast to more traditional models, which consist of medical staff alone who organise workloads independently. Access to more senior and specialist input is identical in both models. Perioperative care (particularly during out-of-hours periods when patients may be most vulnerable to deficiencies in care) is an important determinant of overall outcome. Consequently, the development and implementation of such programmes may have important implications for all those caring for the perioperative patient.