Aim Medical staffing level may not match the increasing demand to deliver safe and sustainable patient care especially during twilight out-of hours. Our aim is to evaluate Junior Doctors staffing (capacity) against medical admissions (demand) in twilight hours, implement a balance between demand and capacity, and evaluate its impact on the number of medical patients handed over to night on-call team.

Method The proposal was presented at Junior Doctor Senate, which was composed of junior doctors and chaired by Director of Medical Education (DME). Baseline data was collected on medical staffing level during twilight hours (5–9 pm) and the number of medical patients still waiting to be seen handed over to night team. The Results were presented at Trust-wide meetings. Invitations were received to present the data to the Trust Directors and Chief Executive. Same set of data was collected after the successful implementation of new twilight shift.

Results Data showed almost half (47%) of all medical referrals were received between 4pm and midnight. After the implementation of twilight shift, the average number of medical staffing level increased from 4.3 to 6.6 (p<0.01) and the average number of medical patients waiting to be seen at 9pm significantly dropped from 14.6 down to 6.8 (p=0.02). Student’s t-test was used for statistical analysis. Feedback (no=39) was collected from all staff groups in the Trust after the implementation, which showed 84% of staff agreed or strongly agreed that increasing staffing level improved safety of patient care.

Conclusion Collaborative working between Junior Doctors, DME and Trust executive resulted in identifying gaps in medical staffing during twilight hours. Our work demonstrates that junior doctors are potentially a powerful group of clinical staff, by speaking up and taking active roles they can lead a culture of positive changes in the Trust.