Virtual hospital promises comprehensive emergency coverage

New European legislation that sets strict limits on working hours is forcing many U.K. hospitals to reassess out-of-hours coverage. As restrictions covering on-call hours for junior doctors and registrars come into play, electronic options for maintaining 24/7 expertise may prove increasingly attractive.

U.K. government officials have circulated a plan to address this dilemma: the "Hospital at Night" project. The proposal outlines cross-cover between specialties and extended diagnostic and treatment roles for nonmedical or nursing staff. But maintaining the quality of overnight care with staff expertise stretched so thinly could be a major challenge, especially in smaller hospitals.

Radiologists and accidents and emergency (A&E) staff at the Central Middlesex Hospital in London believe they have a solution to the problem of maintaining overnight emergency services in the face of reduced staff availability. They are hoping to set up a virtual night hospital as part of a planned new A&E center, using combined resources from several hospitals to offer expert-led consultations from a single site.

"The European Working Time directive is creating all sorts of problems," said Dr. Philip Shorvon, a radiologist at Central Middlesex and a strong advocate of the scheme. "Even at the moment, most A&E departments are run at night by relatively junior doctors who haven't had a huge amount of experience. With the introduction of the Hospital at Night project, even less experienced medical and nonmedical staff will be staffing the hospitals."

The Central Middlesex team would rather let doctors concentrate on what they know best, while offering their skills to a greater number of people. The virtual hospital would be staffed by a radiologist, an A&E consultant, and possibly other experts such as a cardiologist. The team would offer a reporting service for A&E plain films and emergency CT scans, with images transmitted by PACS, and face-to-face consultations available via portable videoconferencing.

"I think the real problem people have with standard teleradiology is that it is so anonymous," Shorvon said. "When you're reporting a study, you get a much better report if you can talk through the case or look at the clinical context in which the study was performed, or even talk to the radiographer who is performing the scan beforehand."

Shorvon and colleagues are seeking partners for a small-scale pilot to test the how concept works and iron out any problems. They hope to have a full-scale virtual night hospital running by 2006, when the planned A&E building is scheduled for completion.

"There is always a certain amount of suspicion when you start changing established working practices," Shorvon said. "But having reached the stage where this is technologically possible, I can see this happening for out-of-hours services eventually."