The impact of COVID-19 on UK anaesthetic departments

Introduction

Rotamap provides online doctor rostering largely to public healthcare organisations in the UK, New Zealand, Australia and South Africa. CLWRota, our anaesthetic rostering system, is used by 116 acute NHS trusts, covering over 12,500 anaesthetists across 134 NHS anaesthetic departments in the UK. According to the NHS Workforce Statistics from January 2020, this accounts for approximately 85% of the NHS anaesthetics cohort[1].

In many cases, anaesthetic departments are at the heart of a Trust’s COVID-19 response. This article sets out some of the dramatic changes occurring in UK anaesthetic departments in response to the pandemic, by looking at activity as recorded in CLWRota. You can learn more about Rotamap's response to COVID-19 here.

Productivity and Leave

Across UK anaesthetic departments, leave and productivity typically follow similar seasonal variations each year, in line with public and school holidays. The line graphs below provide a comparison of these metrics between February and May 2020 and the same dates in 2019.

The top graph shows consultant and trainee activity measured in sessions, where one session represents one part of the day (morning, afternoon, evening or night) worked by one anaesthetist. The bottom graph measures full person-days of leave taken by anaesthetists each day – which can be thought of as the daily number of anaesthetists on leave.

We can see the predictable spike in leave and slight drop in activity over the February school holidays for both years, but the lines begin to diverge in March with the start of the COVID-19 outbreak. Leave initially peaked at the end of March 2020 but then gradually dipped to a lower level than usual, despite the Easter holidays; this was accompanied by a slightly higher than usual level of activity.

Balance of Work During the Week

Whilst the 7-day averages above show slight variation in total activity during the COVID-19 outbreak, a daily breakdown reveals far more radical changes. In the bar graph below, we can see a shift from predominantly weekday-based working patterns to a more even spread of work throughout the week. Weekend work has doubled from an average of around 1,900 daily sessions to almost 4,000 during April weekends.

The graph also includes counts of sessions of work marked as Extra, which represents additional work performed for extra pay.

We note that the change in work distribution through the week is accompanied by a large drop in the amount of work done as Extra, with the average number of Extra sessions per day decreasing from 450 in March to 185 in May.

COVID-19 and Sickness-Related Leave

The surge and subsequent drop in leave taken in 2020 is better understood when broken down by leave type. The peak during the last week of March is a result of a large jump in generic sick leave (from about 270 people per day at the start of March to over 700 at the end of the month) together with approximately 500 daily cases of leave identified as related to COVID-19.

However, other kinds of leave (predominently study leave and annual leave) dropped by a third over the course of April, with a net result of less leave being taken than usual by May.

Cancellations

The number of cancellations recorded on CLWRota gives an indication of the scale of rescheduling of planned work as anaesthetic departments adjust to deal with COVID-19.

The graph below shows a dramatic increase in the count of daily cancelled sessions during March 2020. Weekly cancellations peak at just over 15,500 during the first week of April, compared to an average of around 3,000 cancelled sessions per week in 2019.

Cancellations for which COVID-19 was noted as the reason are represented by the shaded pink area. The x axis represents the date on which the cancelled sessions were scheduled to take place (rather than the date on which they were cancelled).

The temporary drop in cancellations around Easter 2020 is explained by the fact that there would have been fewer sessions scheduled to take place to begin with, due to the public holiday.

Notes

This data is taken from 129 UK anaesthetic departments which have been using CLWRota since before February 2019. Accuracy of the data, and in particular the classification of types of activity, leave and cancellations, depends on accurate input from the departments. Rotamap provides twice yearly benchmarking data packs where departments can verify the validity of how their data is classified. This article assumes the same setup is still correct.

The identification of leave and cancellations related to COVID-19 is not built into CLWRota and relies on processing free text input by its users. This is inevitably subject to variation between departments' procedures.

References:

[1] See NHS Workforce Statistics - January 2020 Doctors by Grade and Specialty.