Specialist on call
Clinical pharmacologists have traditionally taken a particularly active role as general non-organ-based physicians in the on-call rota for the supervision, receiving and triaging of acute emergency admissions and also through the provision of specialist on-call services.
General on-call duties should be undertaken with the support of an appropriate number of junior doctors, including a specialty registrar (SpR). These occur throughout the week, with clinical pharmacologists providing a 7-day service. Acute general medical admissions should ideally be admitted to a medical admissions unit with appropriate staffing and access to emergency investigations. The on-call rota should not be more than one in five. Each period of acute admitting must include a post-take ward round with the junior staff who were involved in the admission process. In some services, two ward rounds may be required in a 24-hour period. Consultants who are responsible for the review of poisoned patients have more frequent post-receiving ward rounds.
A common on-call commitment of a clinical pharmacology service is the provision of emergency advice about the management of poisoned patients. Poisoning is one of the most common reasons for hospital admission. In England alone there were over 170,000 admissions to hospitals with suspected poisoning in 2014/15 and there is a need for expert support for emergency staff. This activity will usually be supported by a poisons information service, and clinical pharmacologists may offer regional advice.
Clinical pharmacologists are important in helping to maintain the expertise and leadership of the UK in experimental medicine research. Some academic specialists may have out-of-hours commitments to people involved in clinical trials or in early phase studies. This may be in conjunction with responsibility for the management of a clinical research facility.
(See the BPS report, Clinical Pharmacology: A dynamic medical specialty essential for UK healthcare, p 19, ‘Clinical pharmacologists champion innovation and experimental medicine in the NHS’.)
Clinical pharmacologists may also provide out-of-hours advice on patients who have adverse drug reactions (ADRs), particularly those that are serious enough to lead to hospital admission. Polypharmacy predisposes patients to ADRs and as the population ages and the prevalence of complex long-term conditions and comorbidities rises, the risk of ADRs will increase. According to a study from 2004, ADRs place a significant burden on the NHS representing at least 6.5% of all admissions, while about 15% of patients develop ADRs as an inpatient, at a cost to the NHS of at least £1 billion annually.