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Streamlining communication between nursing staff and medical teams regarding patients who are 'medical outliers'.

Due to rising demands, hospital beds have become a valuable commodity, no more so than acute medical beds. As a result, patients being admitted under medical specialties may be moved to a non-medical (frequently surgical) ward, becoming a ‘medical outlier’. 
 
Although postulated that these patients have increased inpatient mortality, this has not been proven. However, there is evidence that medical outliers have longer lengths of stay.1 
 
At the Queen Elizabeth Hospital in Birmingham, medical outliers are allocated to multiple medical consultants in an attempt to distribute the workload evenly. There is a designated Band 7 nurse who coordinates medical outliers to ensure each outlying patient has a named consultant. 
 
Despite this pathway, confusion often arises when nursing staff need to contact junior doctors for the corresponding consultant between 9am–5pm. As a result, the on-call team is often contacted regarding these patients. Although the on-call team would be involved in the care of the all medical patients out of hours, they are not involved in the care of medical outlying patients between 9am–5pm Monday to Friday.