Creating a safety culture for the hospital at night

What you may have missed at the recent Improving Patient Flow conference in Sydney

If you were to take one thing away from the recent Patient Flow Conference in Sydney, it would be the importance of creating a patient safety culture in hospitals at night, and the best practice approaches to achieving it.

Royal Melbourne Hospiutal - improved safety culture at night

The Royal Melbourne Hospital recognised a need for a solution which improved their overnight care processes and their nightlife culture.

At the conference, there was plenty of anecdotal evidence highlighting the vast difference between hospital culture during the day and at night, and the impact this has on patient safety after hours.

Supporting this is a recent review of 26 hospitals at night and during regular operating hours. This review discovered that the mortality rate of patients admitted on weekends was as much as 10% higher than for patients admitted on weekdays.

Safety culture at night was unpacked further at the conference by presenter Kate Burns and ‘virtual guest’ Victoria Atkinson, who shared her insights via video. Both are formerly of Royal Melbourne Hospital (RMH) and shared their journey towards the implementation of the Nightlife initiative, which has seen RMH improve the safety culture of the hospital at night, ensuring they deliver best practice treatment around the clock.

Along with Kate’s experience at RMH, she also shared the experiences of Royal Brisbane and Women’s Hospital (RBWH) which drove a similar change.

Hospitals across Australia experience similar problems when it comes to safety at night

Kate started by recounting the specific problems both RMH and RBWH were experiencing around their overnight care, and the impact this was having on the culture of patient safety at night. Specifically:

  •      Patients were delayed in their access to care;
  •      There was a lack of progression of patient care overnight;
  •      Hospitals shifting into “transition mode” at night, becoming temporary custodians of patients instead of caretakers;
  •      Insufficient communication between daytime and after-hours staff;
  •      The absence of standardised clinical handover processes;
  •      An inability to identify and prioritise patients of concern; and,
  •      A tendency to rely on effective responses to after-hours medical emergencies (MERTs) rather than prevention.

As Kate spoke, the murmurs of agreement from the audience served to highlight just how prevalent these issues actually are in hospitals Australia-wide.

It was clear that these were significant problems for these hospitals which had to be addressed as a priority. According to RMH, their “medical staff overnight were siloed. They weren’t working as a team, they weren’t sharing workload equally, and there was no transparency about what people were doing overnight.”

While point solutions may exist, their unconnected nature is an impediment

Whilst RMH and RBWH knew they had issues with overnight care they were tentative about implementing a new technology solution to mitigate these problems. Staff were concerned an entirely new technology would be cumbersome to learn, and may even divide overnight staff more by creating a rift between the tech-savvy and those less-so.

Derailing the journey RMH took to identify their specific requirements for the solution, Kate provided the audience with a list of recommendations around what to look for in any solution they implemented at their own hospitals. The right solution had to:

Patient flow manager customised for RBWH and RMH

Patient Flow Manager was customised in order to develop a tailored solution for both RBWH and RMH

  •      Strengthen communication between staff by providing a planned and collaborative environment for handovers;
  •      Provide a single, comprehensive framework for a standardised communication process;
  •      Provide a single source of truth to capture and access all patient status information;
  •      Allow clinical staff to easily identify and prioritise patients of concern;
  •      Be easy to use to ensure a higher level of compliance by all staff; and
  •      Be customisable to the hospital’s specific requirements.

Already, both RWBH and RMH were using Health IQ’s Patient Flow Manager to achieve increased visibility of their bed management and capacity planning. Almost at the same time, both hospitals reached out to Health IQ’s team asking them to design a solution that could help them underpin the cultural changes they hoped to drive at night.

As long term partners in these hospitals’ innovation journeys, Kate recounts how the Health IQ development team set to work. Critically, Health IQ was able to expand their existing Patient Flow Manager platform and accommodate the needs of both hospitals as they evolved.

From the outset, staff at these hospitals “started to connect as a team”. The 180 degree change in after hours culture truly started to evidence itself shortly after the implementation. Victoria reflected on the transition, “People were actually enjoying coming to work at night!”

Safety culture realised: The numbers tell a compelling story for improving the hospital at night

Finishing off her presentation with triumph, Kate shared insights around how RMH achieved their goal of facilitating a similar level of care at 10pm as they would at 10am. Specifically, they saw an:

  •      Increase in patient safety in the form of a 50% reduction in cardiac arrests; and
  •      Increase in clinician engagement, as evidenced by HMO sick leave reducing 50%

She also shared RBWH’s achievements, with improvements across a variety of metrics including:

  •      A 30% decrease in the number of after-hours MERTs recorded;
  •      100% compliance by doctors when recording and monitoring patients of concern using PFM;
  •      All after-hours MERTs are reviewed every morning by the daytime clinical staff;
  •      Increased compliance with the use of the formal handover templates by the multidisciplinary team; and,
  •      A cultural change involving improved communication and collaboration.
Results of the improved clinical handover process

The number of medical emergency calls (MERTs) decreased significantly after the introduction of the formal after-hours clinical handover process.

Developing a tailored solution which was capable of meeting the unique requirements of each hospital, but was still part of a familiar and hospital-wide system was critical for achieving these results.

This year’s Improving Patient Flow conference in Sydney sought to highlight the importance of creating a culture of patient safety at night. As Kate demonstrated, changing the environment of the hospital-at-night requires cultural change. Critically, Health IQ was able to create a tailored system for managing each hospital’s after hours requirements in order to underpin that change.

For Health IQ, best practice means creating a system which clinicians and staff are keen to use, because they too are involved in the creation process and are partners in the innovation process.

What is your hospital’s capacity to deliver quality patient care overnight? What steps are you taking to drive improvements?

If you are interested in discussing how you can improve your own hospital’s after hours care and safety culture, please give me a call on 1300 554 997 or send me an email to

Learn more about Royal Melbourne Hospital’s or the Royal Brisbane Woman’s Hospital’s journeys towards their improved after hours care:

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