On-call Doctors Research Articles

Hospitalizations, emergency medical care utilization, and contacts with the regional on-call medical services among nursing home residents in Germany: a cross-sectional study in 44 nursing homes

BackgroundNursing home residents frequently utilize medical care, but there lacks a complete picture of their acute medical care utilization. We quantified hospitalizations, emergency medical care utilization, and contacts with the regional on-call medical services among nursing home residents, and investigated individual characteristics that may be associated with the utilization of these medical care types.MethodsCross-sectional data from the “Needs-based provision of medical care to nursing home residents” (MVP-STAT) study were analyzed, which were collected in 44 German nursing homes from 442 residents in 2018/2019. Proportions of residents with at least one hospitalization, emergency medical care utilization (via the nationwide phone number 112), and contact with an on-call medical service (nationwide via 116117) over the previous 12 months were determined. Associations between individual characteristics and the utilization of the three medical care types were examined using multivariable logistic regressions.ResultsOf the analyzed residents, 45.8% were hospitalized, 23.2% utilized emergency medical care, and 12.1% had contact with an on-call medical service at least once in the previous 12 months. Hospitalizations were positively associated with male vs. female sex (adjusted odds ratio 1.99 [95% confidence interval 1.22–3.26]), age group 85 + vs. 60–74 years (2.15 [1.12–4.13]), long-term care grades 4/5 vs. 1/2 (2.78 [1.48–5.21]), 6 + vs. 0–1 Elixhauser diseases (2.58 [1.01–6.62]), and the risk or presence of vs. no malnutrition (3.10 [1.52–6.35] and 2.01 [1.26–3.21]); and not associated with years of residence in the respective nursing home. Emergency medical care utilization was positively associated with age group 85 + vs. 60–74 years (2.58 [1.14–5.84]) and long-term care grades 3 and 4/5 vs. 1/2 (2.65 [1.07–6.55], 6.31 [2.60–15.35]); negatively associated with 5 + vs. 1- < 3 years of residence (0.46 [0.24–0.86]); and not associated with sex, the number of Elixhauser diseases, and nutritional status. No associations were found with on-call medical services.ConclusionsHospitalizations and emergency medical care utilization were more frequent among nursing home residents than contacts with on-call medical services. Future studies should investigate whether the frequent hospitalizations and emergency medical care utilization among nursing home residents are justified, or whether they can be reduced by strengthening medical care provision by on-call doctors and other professionals.Trial registrationDRKS00012383 [2017/12/06].

182 Keyboard Warriors Sparking a Digital Renaissance: The New Frontier in Traumatology Documentation

Abstract Aim To align clinical records with the high-caliber examinations performed, specifically targeting the vague "Neurovascularly Intact" or 'NVI' term. By enhancing record accuracy, the initiative sought to improve patient recovery tracking and provide robust medicolegal documentation, all while easing the workload of on-call doctors. Method Our audit evaluated the initial clerkings by on-call doctors for trauma patients, analyzing 59 records (n=59) against NICE and BOAST standards pre-intervention. To rectify the prevalent use of 'NVI', we introduced an autotext template, activated by 'NVIL' or 'NVIU', which auto-populates with a detailed assessment while allowing clinician customization. Post-intervention, we examined a further 57 records (n=57) to assess the impact on documentation quality. Results Before intervention compliance was poor: Nerve listed (11.86%), motor tested using MRC grading scale (8.47%), sensory tested (22.03%), blood vessel listed (18.64%), CRT tested (18.64%), and limb color recorded (6.78%). After intervention, compliance increased: nerve listed (91.23%), motor function (96.49%), sensory (96.49%), blood vessels (92.98%), CRT (94.74%), and limb color (82.46%). Documentation of 'NVI' reduced from 55.93% to 3.51%. Fisher's Exact Test with post hoc Bonferroni correction shows results were statistically significant (P&amp;lt;0.05). Conclusions This audit heralds an innovative breakthrough by adeptly leveraging system one thinking through technology to enhance documentation in the NHS. By introducing the autotext template, we've elevated documentation precision, strengthened medicolegal safeguards, and shifted the focus from service-dominated tasks to allow time for physician professional growth.This advancement is a significant stride towards balancing the scales, emphasizing the importance of both patient outcomes and physician development in a system under pressure.

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Developing an Electronic Handover System for On-Call Doctors in a South London Mental Health Trust

Emergency Department Presentations to the Mental Health Services at Sligo University Hospital during the COVID pandemic

IntroductionIn March 2020, the WHO declared the outbreak of SARS-CoV-2 a pandemic and Ireland went into its first lockdown. The Mental Health Liaison team at Sligo University Hospital operate 8 am to 8 pm, 7 days a week, with out of hours covered by the on-call Psychiatry junior doctors. The service has seen an increase in referrals, many of whom are known to community mental health teams.ObjectivesWe reviewed the numbers and trends of mental health presentations to the Emergency Department at Sligo University Hospital throughout the pandemic, including the patterns of presentations around the implementation of lockdowns.MethodsThe Liaison Mental Health Service at Sligo University Hospital gathers data relating to numbers and types of presentation to the service. Data was taken from a pre-existing database of psychiatric presentations to the emergency department at Sligo University Hospital including patient demographics, nature of presenting complaint, time period in which they presented and whether they were previously linked in with a community mental health team in the preceding six months. We also looked at the pattern of ED mental health presentations from March 2019 to August 2021. In order to compare psychiatric presentations pre and during covid, data was broken down into two groups: the twelve months preceding March 2020 and the twelve months from March 2020. Categorical data were analysed using the Chi squared test for homogeneity in SPSS.ResultsOverall, there was a 14% increase in mental health presentations during the pandemic. There was a significantly greater proportion of presentations of psychosis during the pandemic period (p&lt;.014) and for medication review (p=.03) and significantly less presenting with addiction (p &lt;0.001). Of those patients seen in the Emergency Department in 2021, 54.3% were known to the CMHT in the previous 6 months. in 2019, mental health presentations made up 1.36% of total ED attendances. This increased to 1.47% in 2020. From January to August 2021, 2.62% of ED attendances were mental health presentations.Image:ConclusionsThe Covid-19 pandemic led to increased mental health presentations to Sligo University Hospital emergency department, with a significantly greater proportion presenting with psychosis and for medication review. These findings have implications around patient care and service provision. These results show that the prevalence of mental health has increased during the pandemic, particularly severe and enduring mental illnesses. New strategies must be implemented to accommodate to this increase in presentations.Disclosure of InterestNone Declared

A38Bridging the gap to FY1 – A high fidelity, regional programme with real life actor-based simulation of the acutely unwell patient

Simulation based learning is becoming an increasingly important focus across medical curricula internationally [1]. The need for medical students to be both theoretically and practically competent is essential in the transition to becoming a successful junior doctor. High technology driven manikin simulations are useful, however access is limited by lack of equipment, finance, and training. In district general hospitals this restricts junior doctors’ exposure to teaching and students’ access to a diversity of cases. Utilizing junior doctors as Near Peer Tutors (NPTs) provides a real life equivalent to the simulation experience that comes closer to exposing trainees to the realities of hospital life as an on-call doctor [2]. A 6-week programme originally designed in a separate NHS Trust was adapted and streamlined with improvements made to data collection, labour division and content delivery. Ten simulation sessions across two district general hospitals ran from 18/10/22 to 21/04/23 with 37 medical students and 8 NPTs. Each week focused on typical, in-hospital scenarios commonly faced by junior doctors. A self-assessment confidence survey and digital knowledge quiz was undertaken on the weekly topic followed by a 10-minute, high yield, interactive lecture delivered by a NPT. Students were split into groups of two and each group assessed the ‘acutely unwell patient’ with an ‘ABCDE’ styled approach to diagnosis and management. The NPT actor simulated improvement or decline based on the management decisions of the students. A STOP5 hot debrief ran at the end to give constructive feedback and promote discussion [3]. Self-assessment confidence scores by medical students were quantified against a 4-point Likert confidence scale. The students’ confidence rating improved by an average of 0.65 units (average pre-teaching = 2.40, average post-teaching = 3.05) (p&lt;0.00001). Following the session, 35/37 students described themselves as ‘quite confident’ managing an emergency scenario compared with 13/37 prior to the session. Thematic analysis of the perceived benefit by students highlighted 3 main areas; an opportunity to engage in practical scenarios, utilization of A-E assessments, and the benefits of real-life actors. Students enjoyed the ‘informal setting’, ‘life like’ encounters, and expressed they would like to attend additional specialty specific sessions. NPT centred medical simulation in a low-cost environment is a compelling method of engaging junior doctors as teachers and equipping medical students with the skills to become future on-call doctors. We encourage the implementation of similar programmes alongside medical school curricula to supplement preparation for practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Evaluating Completeness of Admissions Clerking Procedure for Patients Admitted to an Acute Psychiatric Inpatient Unit

AimsThere is a well-known bidirectional relationship between mental and physical health. A thorough mental and physical health assessment of new inpatients on admission is crucial to assess possible organic causes of psychiatric presentations and enable appropriate treatment to be commenced in a timely manner. We noted a pattern of incomplete clerking, leading to delays in commencing treatment and increased workload pressure on the ward medical team. Our audit aims to assess how thoroughly and in what time frame patients' admission assessments are being completed on an acute psychiatric inpatient unit.MethodsA sample of 20 patients was used for each cycle. Eight components were identified from the Trust clerking procedure. These were a full psychiatric history, capacity assessment, prescription chart, physical health systems review, physical examination, blood tests, ECG and VTE assessment. The expected standard was completion of all of the above at the point of admission or, if applicable, adequate documentation of patient refusal with documented reattempt within 24 hours.Electronic patient records were retrospectively reviewed to identify whether each component was completed, the number of days from admission to completion and if completed by the clerking doctor. Evidence of documented patient refusals and the number of incomplete draft entries were noted.ResultsInitial results showed only 20% of patients (n = 4) had the full expected clerking procedure completed at admission. Physical health assessments (ECG, blood test, physical examination) had the lowest completion rates. When components were not completed by the clerking doctor, there was often a delay of several days from admission to completion of by the ward day team. For 50% of patients, some assessments were never completed (without adequate refusal documented). Eight patients did not have a completed VTE assessment by the point of discharge.ConclusionReasons were identified for the poor completion rates of clerking assessments. These included a lack of understanding by on-call doctors about the importance of completing all assessments, unfamiliarity with ward equipment, lack of adequate handover to the ward medical team and staffing pressures. A new handover checklist was introduced for clerking doctors to use and enable better communication with the ward team. Clerking procedure summaries were displayed in on-call rooms and additional teaching was organised.

258 The Impact of Types of Clerking Document on the Compliance of Initial HAT Risk Assessment on Admission in Trauma and Orthopaedic Patients

Abstract Aim Assessment of risk of venous thromboembolism (VTE) is crucial as VTE is a significant problem in surgical patients. Trauma and orthopaedic (T&amp;O) patients have additional risks given lower limbs and/or pelvic surgery with restricted mobility periods/ weightbearing status. Risks should be assessed as soon as possible after admission. At this point, clerking is a first point of patients’ information gathering. This study aims to examine the compliance of VTE risk assessment on admission against guideline and its relation to the types of clerking proforma. Method A QI project was undertaken using PDSA cycle analysing documents of clerking and VTE risk assessment in 44 T&amp;O patients. Education sessions and routine reminder emails were conducted aimed at oncall doctors receiving admissions. A further 44 patients’ records were audited after 3 months. Primary outcome: VTE risk assessment completion on admission, secondary outcome: impact of types of admission pro-forma upon risk completion rate. Results Initial VTE risk assessment compliance was improved after interventions: from 77.27% to 88.63% generally and from 69% to 100% full compliance particularly in neck of femur cases. Use of structured pro-forma can increase the compliance rate of 91.3% (pre-intervention) to 100% (post-intervention) compared to other 2 freehand documents: 91% Vs 85.71% and 30% Vs 63.64%. Conclusions VTE risk assessment is improved through education sessions, and it is evident the use of structured clerking document can help to optimize the compliance rate although further sustained input is needed to achieve the targeted compliance rate.

Reducing potentially avoidable tasks in a hyperacute stroke unit

The workflow in a stroke unit can be very high, and this is especially noticeable during evening and night shifts, where staffing is reduced but the patient’s need for frequent...

Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)

AimsThis audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.BackgroundMental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.MethodElectronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.Simple statistical analysis was carried out using excel.ResultOver 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.ConclusionTaken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.

Helicopter emergency medical service (HEMS) activity after increased distance to out-of-hours services: an observational study from Norway

BackgroundOrganizational changes in out-of-hour (OOH) services may have unintended consequences for other prehospital services. Reports indicate an increased use of helicopter emergency medical services (HEMS) after changes in OOH services in Norway due to greater geographical distances for the on-call doctors. We investigated whether HEMS dispatches increased when nine municipalities in Sogn og Fjordane County merged into one large inter-municipal OOH district.MethodsAll primary dispatches of the HEMS in the county between 2004 and 2013 were included. We applied interrupted time series regression to monthly aggregated data to evaluate the impact of the organizational change 1 April 2009. The nine target municipalities were compared to the rest of the municipalities in the county, which served as a control group. A quasipoisson model adjusted for seasonality was found to be most applicable.ResultsWe included 8,751 dispatches, 5,009 (57.2%) of which were completed with a patient encounter. Overall, we found no alteration in requests for HEMS after 2009 (p = 0.251). Separate analyses of the target municipalities and control group revealed no significant increase after 2009 (p = 0.400 and p = 0.056, respectively). When categorizing the municipalities into urban or rural, we found a general increase in HEMS dispatches for the rural group over the 10-year span (p = 0.045) but no added increase after 2009 (p = 0.502). The urban subgroup showed no change. Distance from the OOH service in regards to travel increased within the nine municipalities after 2009, median [quartiles] (5.0[3.0, 6.2] km vs 26.5[5.0, 62.2] km, p < 0.001).ConclusionAfter relocating nine local OOH services into one large inter-municipal OOH district, we found no increase in requests for HEMS.

Weekend handover: Improving patient safety during weekend services

Clinical Handover has been identified as one of the most high-risk processes within medicine. Inadequate handover is a significant cause of avoidable adverse events across many hospitals. A likert-survey of the weekend handover system at a district general hospital demonstrated significant dissatisfaction amongst junior doctors. Intending to improve patient safety and reduce stress for on-call junior doctors, a weekend handover proforma was compiled according to the Royal College of Physicians and Surgeons guidelines. The proforma was trialed on six medical wards for six months with a before and after questionnaire being sent to doctors on the wards involved to determine the proforma’s merits on a scale of 1 (least effective) to 10 (most effective). Reports subsequent to implementation demonstrated a 67% increase ease of identifying outstanding weekend jobs. 57% of doctors reported better understanding of their patient’s diagnosis and management plan and 53% stated it was easier to identify the patients that required regular medical review over the weekend. Results also highlighted a 55% reported an increase in safety of weekend handovers (p<0.01). A closed loop audit of handover practice through the use of a standardised proforma showed improved quality, detail and consistency of handovers. The reduction in stress for junior doctors managing unknown patients with a clear concise plan, directed by a senior from the parent team during the week, has improved patient safety and doctor satisfaction.

Predictors of Intershift Fatigue Recovery Among Doctors

Introduction: Doctors are exposed to various psychosocial hazards such as high task demands and demanding work schedule which may influence fatigue, recovery, stress, job satisfaction, wellbeing, and work-family interface. This research generally aims to examine the interrelationship between work-home domain variables with outcomes of fatigue, its recovery, and others related outcomes such as work-to-family conflict, general wellbeing, and perceived stress level among doctors working at public hospital at general and day-level on-call duty.&#x0D; Methods: This is a multicenter analytical mix cross sectional (general) and longitudinal (day-level) research among proposed 390 randomly-sampled on-call doctors working at seven core clinical disciplines from seven public tertiary hospitals in Malaysia. Data will be collected three times: (a) any days after obtaining informed consent (cross sectional), (b) at the end of on-call duty (first wave longitudinal), and (c) at the beginning of subsequent work period (second wave longitudinal). Data will be modelled by covariance-based structural equation modelling (SEM).&#x0D; Conclusion: This research is well justifiable in view of limited available research on complex interrelationship of work domain, home domain and work-home boundary control with fatigue, recovery and other psychological health consequences (e.g. stress, wellbeing, work-home conflict) among doctors, particularly in Asia and developed countries, including Malaysia. This research is expected to provide strong evidence to policy makers in developing prevention and management policy related to fatigue, recovery and other psychological health consequences among doctors.&#x0D; Keywords: doctor, fatigue, recovery, on-call, intershift, wellbeing, stress,

Simulated on-call: time well spent.

Newly qualified doctors feel unprepared to take responsibility for patients and work independently, lacking confidence in skills essential during on-calls. We designed this study to assess the educational value of simulated on-calls and to explore the characteristics of this approach that contribute to improving students' preparedness. A total of 38 final-year medical students attended two sessions, each including a simulated on-call followed by a one-to-one debriefing. Students' confidence and perceived preparedness before and after the programme were measured using questionnaires. Students' performance in two on-call skills was also assessed during both sessions. Focus groups explored the challenges of preparing for on-calls and how this approach enabled students to prepare. Following the programme, students felt significantly more confident in six key skills and significantly more prepared for on-calls (p<0.001). There was also a significant improvement in students' assessed performance in on-call skills (p<0.001). All students found it more useful preparation for on-calls than seminars and shadowing on-call doctors. They appreciated the opportunity to work independently and take responsibility in a stressful but safe environment. Having a second session and receiving one-to-one debriefing with personalised feedback enabled students to maximise their learning. Following the programme, students had better insight into on-call work and felt that the programme should be a mandatory part of training. The opportunity for students to consolidate learning through personalised feedback and a second session maximised the value of the programme, making the significant time commitment from the facilitators worthwhile. This programme was feasible to run and its educational value supports its wider use.

The effects of bleeps on medical on-call doctors' workflow and work efficiency.

While bleeps are a reliable and rapid method of communication, frequent bleeps cause interruption in patient care and disruption to workflow for the receiver.1,2 Furthermore, clinicians sending a bleep can wait an average of 9.35 minutes for a reply,3 representing significant inefficiency. Local feedback from junior doctors reflects the above. This project describes the volume of bleeps received by out-of-hours medical doctors within our hospital and the reasons they are sent. Understanding current activity will support planning for effective and efficient communication in future. Switchboard data was inspected to identify the frequency and timing of bleeps sent to doctors on-call covering medical wards …

The effects of bleeps on medical on-call doctors’ workflow and work efficiency

While bleeps are a reliable and rapid method of communication, frequent bleeps cause interruption in patient care and disruption to workflow for the receiver.1,2 Furthermore, clinicians sending a bleep can wait an average of 9.35 minutes for a reply,3 representing significant inefficiency. Local feedback from junior doctors reflects the above. This project describes the volume of bleeps received by out-of-hours medical doctors within our hospital and the reasons they are sent. Understanding current activity will support planning for effective and efficient communication in future. Switchboard data was inspected to identify the frequency and timing of bleeps sent to doctors on-call covering medical wards …

Experience and Availability of Pelvic Binders at Swedish Trauma Units; A Nationwide Survey.

Objective:To assess availability, experience, and knowledge about the Pelvic Circumferential Compression Device (PCCD) in Sweden.Methods: A telephone interview with the current on-call trauma doctors at all trauma units in Sweden was conducted. After a short presentation and oral consent, the doctors were asked to answer four short questions. We asked the doctors to answer whether they knew if they had PCCDs available in their emergency room, how many times had they applied a PCCD, which is the correct level of application for a PCCD, and if a PCCD can stop arterial bleeding. Results:The on-call trauma doctors at the nine University hospitals, twenty-two General hospitals and twenty-one District General hospitals, with response rate of 100%, were interviewed. Availability of PCCD was 85 % and there was no difference between hospital types (p=0.546). In all hospitals 29/52 (56%) of those interviewed had used a PCCD at least once. There were significantly more doctors that had used a PCCD at least once in the University hospitals (8/9), compared to General hospitals (13/22) and District General hospitals (8/21) (p=0.034). A total of 43/52 (83 %) doctors defined the greater trochanters as the correct level of application for a PCCD. No difference was found when comparing hospitals (p=0.208). Only 22/52 (42 %) of doctors answered that a PCCD could not stop an arterial bleeding. No difference was found between hospitals (p=0.665)Conclusion:Less than half of the doctors knew that a PCCD cannot stop arterial bleeding, while the majority knew the correct level of application of a PCCD.

End-of-Life Care and Discussions in Japanese Geriatric Health Service Facilities: A Nationwide Survey of Managing Directors' Viewpoints.

Geriatric health service facilities (GHSFs) play important roles as intermediate care facilities for elderly individuals temporarily when they need rehabilitation before returning home. However, the number of residents spending their end-of-life (EOL) period in such facilities is increasing. To improve the quality of EOL care, end-of-life discussions (EOLDs) are recommended by some guidelines and studies. This study aimed to clarify the current practice of EOL care and EOLDs in GHSFs in Japan. We conducted a nationwide cross-sectional survey by mailing questionnaires about EOL care and EOLDs to 3437 GHSF managing directors. The questionnaire was developed through a literature review and discussion among the researchers and experts. Descriptive statistics summarized the data. We also analyzed the factors related to GHSFs conducting EOLDs using Fisher exact tests. The response rate was 20.7% (713 of 3437). Among the respondents, 75.2% (536 of 713) of GHSFs provided EOL care and 73.1% (521 of 713) conducted EOLDs. The most common reasons for difficulties in providing EOL care included the lack of EOL education for nurses and care workers, and their fear about caring for dying residents. End-of-life discussions were mostly initiated after the deterioration of a resident's condition and were conducted with families by physicians. Statistically significant factors of GHSFs conducting EOLDs included providing EOL education for nurses and care workers, availability of private room for critically ill residents, emergency on-call doctors, and EOL care. Adequate practical staff education programs for EOL care including EOLDs may be crucial for quality of end-of-life care in aged care facilities.

Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability.

Increasing Medical Students' Confidence in Procedural Skills Using a Junior Doctor-Delivered Bedside Supervision Program

Problem:Clinical procedural skills are formally taught to medical students in clinical skills centers using mannequins. Exposure to procedural skills involving patients and opportunities to practice under the supervision of doctors are limited. Intervention: A bedside supervision program was piloted at a district general hospital in the United Kingdom. The supervision model was chosen as the method to increase medical students' practice in basic procedural skills because it allowed safe practice with patients. Context: The program was an optional component of the medical students' clinical clerkships. Off-duty junior doctors were recruited as voluntary trainers. The trainers obtained requests for procedural tasks from the on-call doctors and ward nurses, following which the trainers supervised medical students performing the basic procedures with patient consent. Outcome: The pilot program was successfully run for 4 weeks. Fourteen students took part, and 9 (64%) completed a postintervention feedback questionnaire. The students' confidence (rating scale = 1–5) in performing procedural skills improved from a mean of 3.0 (SD ± 0.9) to 4.7 (SD ± 0.5) following a supervision session. Although the range of skills was limited to opportunistic encounters, the students reported high satisfaction and felt supervision enabled them to identify areas for improvement. Lessons Learned: It is feasible to implement a junior doctor-delivered bedside program to supplement procedural skills training provided by medical schools. The challenges include reconciling the tension between junior doctors' service work and their teaching commitment, logistical issues such as recruiting a sufficient number of trainers and ensuring adequate coverage of training tasks.

Early triaging using the Modified Early Warning Score (MEWS) and dedicated emergency teams leads to improved clinical outcomes in acute emergencies

The Modified Early Warning Score (MEWS) is a well-established score to guide the early involvement of medical on-call doctors in managing unwell patients in acute emergencies. The MEWS score is based on data derived from four physiological readings including systolic blood pressure, heart rate,