Poor IT Placing Patients at Risk Junior Doctors Warn

Improved communications systems that reflect the radically changed working practices in hospitals are vital to guarantee patient safety, a new report by the BMA’s Junior Doctors Committee concludes.

The report, ‘Making IT work for Junior Doctors’, produced to identify problems and solutions to better inform and influence the development of the National Programme for IT in the NHS (NPfIT), says that hospital information systems have failed to keep up with changes in working patterns, putting patients at risk. Urgent improvements are called for.

It warns that the failure of hospital information systems to keep pace with changing working practices has led to a situation in which doctors frequently have to resort to typing their own patient lists on a home computer. Others now carry around details of their patients on a floppy disk to allow essential information to be shared with colleagues – potentially in breach of data protection and patient confidentiality requirements.

In particular, the report highlights that with the limits of junior doctors hours set to become a contractual right from August, working patterns are shifting rapidly away from resident on-call rotas to shift systems. This means that the traditional continuity of care provided through doctors working long hours can no longer be relied on. Doctors taking over at a change of shift can now find themselves responsible for up to 100 patients they have not previously cared for.

Changes in bed management practice further compound the problem, as responsibility for a patient can change several times a day, making it difficult for nurses to know which doctor to contact in an emergency and to identify which doctor is caring for which patient.

The report notes, for instance, that when a patient presents to A&E, the receiving clinicians often do not have the patients’ hospital notes available until several days post-admission, leading to “the potential for harm and inconvenience to patients”.

“This makes reliable mechanisms for the exchange of information essential,” stresses the report. Without such systems “Information about patients can be lost in the systems potentially leading to misdiagnosis, delays to treatment, and prolonged hospital stays.”

BMA Junior Doctors Committee deputy chairman Simon Eccles stated: “The NHS urgently needs to develop information systems that take changes to working practices into account. If these problems are not addressed there will be unacceptable risks to patients.”

The BMA report makes a series of recommendations:

• An electronic diary linking doctors’ contact details to their duty rotas so that the right doctor can be contacted in an emergency;


• Replacing hospital bleep systems with mobile communications devices that can differentiate between emergencies and other requests;


• Development of systems to support the handover of critical patient information and outstanding tasks at shift changes;


• Technology to allow doctors to report results and order treatments from the patient’s bedside;


• Better access to clinical information through hospital intranets and the National Electronic Library for Health.