The quality and safety of locum doctors: a narrative review

Abstract

SummaryLocum doctors are often perceived to present greater risks of causing harm to patients than permanent doctors. After eligibility and quality assessment, eight empirical and 34 non-empirical papers were included in a narrative synthesis to establish what was known about the quality and safety of locum medical practice. Empirical literature was limited and weak methodologically. Locums enabled healthcare organisations to maintain appropriate staffing levels and allowed staffing flexibility, but they also gave rise to concerns about continuity of care, patient safety, team function and cost. There was some evidence to suggest that the way locum doctors are recruited, employed and used by organisations, may result in a higher risk of harm to patients. A better understanding of the quality and safety of locum working is needed to improve the use of locum doctors and the quality and safety of patient care that they provide.

‘You're just a locum’: professional identity and temporary workers in the medical profession

“…These findings support earlier calls for the debate about locum doctors and quality to extend beyond the monitoring of locum performance to include the working environment (Ferguson and Walshe 2019, McKevitt et al . 1999).…”

“…Locum doctors are more likely to have complaints made about them than other doctors (General Medical Council 2014) and are often perceived to present a higher risk of causing harm to patients than permanent doctors (Godlee 2010, Isles 2010, Jennison 2013). A recent review found that there was little empirical evidence to show differences in the quality and safety of locum and permanent doctors' practice, and concluded that many of the factors which may plausibly affect the quality and safety of locum practice are more concerned with the way organisations use locums and how they are deployed and supported than with the characteristics of locum doctors themselves (Ferguson and Walshe 2019).…”

Hospitalization and Post-hospitalization Outcomes Among Teaching Internal Medicine, Employed Hospitalist, and Locum Tenens Hospitalist Services in a Tertiary Center: a Prospective Cohort Study

“…Despite the utilization of locum physicians is pervasive in the USA and the rest of the world, [11][12][13][14][15][16] their outcomes are mostly unknown. [19][20][21] Only one study has investigated locum physician outcomes in patients admitted to IM services (Table 2). 21 The study sample included 38,475 Medicare admissions treated by locum physicians in plurality compared to 1,780,398 admissions treated by IM physicians.…”

“…Moreover, many believe that locum physicians provide lower patient safety and quality of care. 10,19 However, there are few retrospective studies and no prospective studies investigating care provided by locum physicians in different medical specialties. [19][20][21] Blumenthal et al found that Medicare fee-for-service beneficiaries treated by locum physicians in plurality had similar mortality, higher hospital cost (HC), longer stay, and lower 30-day readmission compared to non-locum internist.…”

“…10,19 However, there are few retrospective studies and no prospective studies investigating care provided by locum physicians in different medical specialties. [19][20][21] Blumenthal et al found that Medicare fee-for-service beneficiaries treated by locum physicians in plurality had similar mortality, higher hospital cost (HC), longer stay, and lower 30-day readmission compared to non-locum internist. 21 In this prospective cohort study, we compare LOS, cost of hospitalization, inpatient mortality, 30-day all-cause readmission, and 30-day mortality in hospitalized patients treated by teaching IM vs. non-teaching hospitalist services at a single institution.…”