Dear Editor,

I refer to an article in the Courier Mail (& February 2005) regarding recent research in the latest edition of Australian Health Review (AHR) regarding out of hours medical coverage in a Brisbane major metropolitan teaching hospital.  These researches concluded that almost two thirds of after hours call outs for doctors are of a routine or non-urgent nature and were perceived to be medically inappropriate or not essential by the doctors involved in the study. 

Importantly the researchers identified a number of strategies to reduce inappropriate out of hour’s requests that were not reported in your article.  These included ensuring that routine medication and fluid orders being written by primary treating medical staff before they go off duty, iv cannulation and venesection being performed by phlebotomists or skilled advanced practice nursing staff and the implementation of clinical protocols that would enable nurses to adjust medication dosages.

Many of the inappropriate call outs reported in the research resulted from doctors on the day shift failing to write up appropriate fluid or medication orders.  Currently in most instances nurses have no choice other than to call an after hours medical officer to ensure a lawful order is provided.  This is inefficient use of resources and annoying for nursing and medical staff alike, taking up valuable time of all parties.

In responding to this research, AMAQ President Dr David Malloy appears to have missed the point completely. His position also appears to be at variance with that of the AMAQ representative on the Queensland Health Nurse Practitioner Steering Committee.  This committee has been operating for some years now.  The AMAQ have not indicated any opposition to the initial trial of nurse practitioner roles in 2003 nor the current extension of this trial to seven demonstration sites.  

The introduction of nurse practitioners in Queensland would in part address some of the serious issue raised in the AHR study.  Rather than attempting to pass the blame and at the same time denigrate their nursing colleagues, the AMAQ would be better placed to continue to work with nurses to bring about the introduction of an appropriate model of nurse practitioner in Queensland.  This would result in the more effective and efficient use of scarce health resources in this state.

Gay Hawksworth

Secretary