Psychiatry after-hours: factors impacting workload and workflow

Objective: The study evaluated the workload and workflow of registrars engaged in a psychiatry after-hours roster, quantified their perceptions of this experience and provided recommendations for system redesign. Method: Multiple sources of information, including medical student observers and telephone logs, quantified the tasks performed during shifts. Registrars completed a satisfaction questionnaire. Results: After-hours shifts often started with a lack of attendance of key clinicians at handover. Tasks handed over and completed during shifts varied; there was very little difference between evening, weekends and night shifts except for the higher likelihood of seclusion reviews on weekends. Registrars experienced a significant and complex workload including emergency department and ward reviews, and admissions. Workflow interruptions were frequent; the high number of phone calls and critical incidence warrant further investigation. Registrars were confident in their own ability, but ha