Research Output

Improvement in out-of-hours outcomes following the implementation of Hospital at Night

  Background: Hospital at Night (H@N) is a Department of Health (England) driven programme being widely implemented across UK. It aims to redefine how medical cover is provided in hospitals during the out-of-hours period.
Aim: To investigate whether the implementation of H@N is associated with significant change in system or clinical outcomes.
Design: An observational study for 14 consecutive nights before, and 14 consecutive nights after the implementation of H@N. Data were collected from the Combined surgical and medical Assessment Unit (CAU), the 18 medical/surgical wards (The Ward Arc) and the four High Dependency Units (The Critical Care corridor) within the Royal Infirmary of Edinburgh.
Methods: Following an overnight episode of clinical concern, data were gathered on response time, seniority of reviewing staff, patient outcome and the use of Standardized Early Warning Score (SEWS).
Results: Two hundred and nine episodes of clinical concern were recorded before the implementation of H@N and 216 episodes afterwards. There was no significant change in response time in the CAU, Ward Arc or Critical Care corridor. However, significant inter-speciality differences in response time were eradicated, particularly in the Critical Care corridor. Following the implementation of H@N, patients were reviewed more frequently by senior medical staff in CAU (28% vs. 4%, P < 0.05) and the Critical Care corridor (50% vs. 22%, P < 0.001). Finally there was a reduction in adverse outcome (defined as unplanned transfer to critical care/cardiac arrest) in the Ward Arc and CAU from 17% to 6% of patients reviewed overnight (P < 0.01). SEWS was more frequently and accurately recorded in CAU.
Conclusion: This is the first study that we are aware of directly comparing out-of-hours performance before and after the implementation of H@N. Significant improvements in both patient and system outcomes were observed, with no adverse effects noted.

  • Type:


  • Date:

    21 May 2009

  • Publication Status:


  • Publisher

    Oxford University Press (OUP)

  • DOI:


  • Library of Congress:

    RA Public aspects of medicine

  • Dewey Decimal Classification:

    610 Medicine & health


Beckett, D. J., Gordon, C. F., Paterson, R., Chalkley, S., Stewart, C., Jones, M. C., …Bell, D. (2009). Improvement in out-of-hours outcomes following the implementation of Hospital at Night. QJM : monthly journal of the Association of Physicians, 102(8), 539-546. doi:10.1093/qjmed/hcp056



Hospital at Night (H@N), out-of-hours medical care, clinical care,

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