Doctor safety in Australian after-hours house-call medical services: the use of chaperones and chauffeurs

Objectives: The use of escorts (chauffeurs and chaperones) while on duty in after-hours-house-call (AHHC) is one key protective option available to doctors in the service and has been linked to low burnout and increased satisfaction in AHHC. This study aims to explore the patterns of engagement of escorts in Australian AHHC. Method: A questionnaire-based, electronic survey of all 300 doctors involved in AHHC through the National Home Doctor Service (NHDS), Australia’s largest providers of the service. Results: : A total of 168 valid responses (56.0%) were received. 60.8% of the doctors engaged escorts. Of the doctors that engage chauffeurs, three-quarters do so “all or most times”, while only one-quarter engage chaperones to the same degree of frequency. Hiring escorts is very popular among Brisbane (91.7%) and Sydney-based (88.2%) practitioners, but is unpopular in the City of Gold Coast (26.1%). There were moderate patronages in Adelaide (52.9%) and Melbourne (46.4%). Compared to females, males were more likely to drive themselves (OR 5.34; P=0.001; CI 2.08 to 13.74) and less likely to use chauffeurs (OR 0.19; p<0.001; CI 0.07 to 0.51). Doctors in legally recognized social unions (OR 0.24; p=0.03; CI 0.07 to 0.83) and those that have attained the postgraduate fellowships (OR 0.43; p=0.02; CI 0.21 to 0.87) were both less likely to work without escorts. Conclusion: More needs to be done to increase the engagement of escorts by doctors involved in the Australian AHHC, particularly given their proven benefits in the service. Future studies may be needed to fully explore the real reasons behind the significant associations identified in this study.