854 Bridging the Communication Gap in Surgery: A Quality Improvement Initiative to Improve Surgical Juniors’ Confidence in Navigating Difficult Conversations and Documentation

Abstract

Abstract Aim In response to the challenges faced by surgical juniors in communicating with critically ill patients and their families, particularly after emergency surgery, we initiated a comprehensive two-pronged QIP. Our aims were 1) to enhance skills and confidence of surgical juniors in navigating difficult conversations, and 2) to improve documentation of post-operative patient and NOK discussions after ITU step-down to ward, in-line with NICE guidelines (CG83-1.13). Method A retrospective analysis of 14 laparotomy patients in September 2023, revealed that only 36% had documented NOK discussions 3-5 days post-operatively, falling short of best practice guidelines recommending documentation within 12 hours. Only 33% of the 10 patients requiring ITU admission, received documented NOK updates post-step-down to the ward. Interventions to address this included developing a communication skills workshop and implementing colored cards in notes folders to visually identify patients needing NOK discussions. Results Pre- and post-workshop surveys, utilizing a 1-to-5 scale, measured confidence levels of junior doctors for difficult discussions, with 13 and 9 respondents, respectively. High confidence scores (4 or 5) for different discussion types showed substantial improvement post-workshop: DNACPR (31% vs. 89%), end-of-life (31% vs. 55%), emotionally charged (31% vs. 78%). Furthermore, 100% of participants post-workshop were highly likely (4 or 5) to utilizing communication frameworks e.g., SPIES. Conclusions Our interventions have demonstrated a significant improvement in the confidence of surgical juniors when navigating challenging conversations. Our ongoing efforts include expanding our ‘communication in surgery’ workshop series, which we hope to present, and a re-audit of NOK discussion documentation to objectively measure positive changes post-intervention.