Acute hospital medical staffing during the night shift.

There has been little or no attempt to define the need for 24-hour medical cover, nor its appropriateness in acute hospitals, despite the great cost implications and the question of the quality of that care. This study examined the medical activity during the 'night shift' in an acute hospital. There were an average of 2.59 calls per night, most from the emergency department (247/475) and general wards (108/475). Many calls were related to active resuscitation (88/475) and immediate treatment (83/475). Over 40% (81/286) of patients had to be transferred to a higher level of care, such as an intensive care unit within the hospital. By collecting data on the demands of health care during what amounts to over a third of the hospital's time, it was established that a high level of medical care was required. Appropriate levels of staffing, using junior doctors trained in acute medicine, was able to be provided to match need as determined by these data, and extra staff at higher costs were avoided.