Reduction In Junior Doctors Research Articles

The current state of the surgical care team in the United Kingdom: Shall we 'do a time out'?

The reduction of junior doctors' working hours over the last two decades paved the way to non-medical practitioners providing care traditionally discharged by surgeons and other medics. These registered practitioners play a vital role in the care of patients in surgery and work within multi-disciplinary teams comprising surgical care practitioners, advanced clinical practitioners in surgery, and physician associates, with significant experience in nursing or allied health care professional practice. Health Education England and the Royal Colleges of Surgeons have invested considerably in developing the relevant educational frameworks to support and quality assure the training of non-medical practitioners. Notwithstanding, to ascertain whether advanced and extended practice have been developed appropriately, a wide critical stance is needed. This article aims to begin to analyse the status quo of the extended surgical team and of the associated pitfalls and challenges, making conservative comparisons between the roles with the international scene. The objective is to help students, trainees and all involved in surgical care to adopt an informed and critical viewpoint about the extended surgical team in the United Kingdom, in the hope that this can lead to improvement and forward planning in workforce design for the benefit of patients and their communities.

Implementation and evaluation of a good prescribing tip email to reduce junior doctors' prescribing errors

Background Prescribing errors are common, occurring in 7% of in-patient medication orders in UK hospitals. Foundation Year 1 (F1) doctors have reported a lack of feedback on prescribing as a cause of errors. Aim To evaluate the effect of implementing a shared learning intervention to Foundation Year 1 doctors on their prescribing errors. Methods A shared learning intervention, ‘good prescribing tip’ emails, were designed and sent fortnightly to F1s to share feedback about common/serious prescribing errors occurring in the hospital. Ward pharmacists identified prescribing errors in newly prescribed in-patient and discharge medication orders for 2 weeks pre- and post-intervention during Winter/Spring 2017. The prevalence of prescribing errors was compared pre- and post-intervention using statistical analysis. Results Overall, there was a statistically significant reduction ( p < 0.05) in the prescribing error rate between pre-intervention (441 errors in 6190 prescriptions, 7.1%) and post-intervention (245 errors in 4866 prescriptions, 5.0%). When data were analysed by ward type there was a statistically significant reduction in the prescribing error rate on medical wards (6.8% to 4.5%) and on surgical wards (8.4% to 6.2%). Conclusions It is possible to design and implement a shared learning intervention, the ‘good prescribing tip’ email. Findings suggest that this intervention contributed to a reduction in the prevalence of prescribing errors across all wards, thereby improving patient safety.

“That was a good shift”

PurposeThe purpose of this paper is to investigate a boundary spanning, interprofessional collaboration between advanced practice nurses (APNs) and junior doctors to support junior doctors’ learning and improve patient management during the overtime shift.Design/methodology/approachA mixed methods evaluation of an intervention in an adult tertiary referral hospital, to enhance interprofessional collaboration on overtime shifts. Phase 1 compared tasks and ward rounds on 86 intervention shifts with 106 “regular” shifts, and examined the effect on junior doctor patient management testing a model using regression techniques. Phase 2 explored the experience of the intervention for stakeholders. 91 junior doctors participated (89 percent response rate) on 192 overtime shifts. Junior doctors, APNs and senior medical professionals/administrators participated in interviews.FindingsThe intervention was associated with an increase in self-initiated ward rounds by junior doctors, partially explained by junior doctors completing fewer tasks skilled nurses could also complete. The intervention significantly reduced doctors’ engagement in tasks carried over from day shifts as well as first year (but not more experienced) junior doctors’ total tasks. Interviews suggested the initiative reduced junior doctors’ work pressure and promoted a safe team climate, situation awareness, skills, confidence, and well-being.Originality/valueJunior doctors overtime shifts (5 p.m. to 11 p.m.) are important, both for hospitals to maintain patient care after hours and for junior doctors to learn and develop independent clinical decision making skills. However, junior doctors frequently report finding overtime shifts challenging and stressful. Redesigning overtime shifts to facilitate interprofessional collaboration can improve patient management and junior doctors’ learning and well-being.

Does money or the law reduce doctors' working hours in the UK?

What can be learned from a 45-year journey to reduced junior doctors' working hours? The authors investigated the impact of financially punitive measures (the 2001 New Deal contract) and legislation (Working Time Regulations) on the average working week for doctors-in-training.

Paramedic prescribing: a potion for success or a bitter pill to swallow?

In a climate of unprecedented demand on healthcare services, ageing demographics, population growth through immigration, a reduction in junior doctors' working hours, and overriding political agendas, the need to develop innovative new roles and expand the scope of practice for existing practitioners, including paramedics, is paramount if the NHS is to maintain resilience in an evolving healthcare system. Recent legislative changes now permit chiropodists/podiatrists and physiotherapists to independently prescribe, further fuelling other allied health professions (AHPs), such as paramedics' and radiographers' desire to become future independent prescribers. Implementation has the potential to enhance patient/clinician experiences through improved access to medicines, and would significantly reduce the need for multi-disciplinary involvement per care episode, yielding cost-efficiency savings through reduced ambulance journeys, fewer avoidable admissions, further augmenting patient care delivery. Paramedic independent prescribing (PIP) would also elicit improved inter-professional collaboration, enhance employability and promote professional autonomy in evolving advanced practice roles. Such innovation requires legislative changes, but remains paramount if paramedics are to actively contribute towards tackling the increasing burden of unprecedented demand, limited resources, and ongoing commitment to achieve cost-efficiency savings within the modern NHS.

Perspectives on the working hours of Australian junior doctors.

The working hours of junior doctors have been a focus of discussion in Australia since the mid-1990s. Several national organizations, including the Australian Medical Association (AMA), have been prominent in advancing this agenda and have collected data (most of which is self-reported) on the working hours of junior doctors over the last 15 years. Overall, the available data indicate that working hours have fallen in a step-wise fashion, and AMA data suggest that the proportion of doctors at high risk of fatigue may be declining. It is likely that these changes reflect significant growth in the number of medical graduates, more detailed specifications regarding working hours in industrial agreements, and a greater focus on achieving a healthy work–life balance. It is notable that reductions in junior doctors’ working hours have occurred despite the absence of a national regulatory framework for working hours. Informed by a growing international literature on working hours and their relation to patient and practitioner safety, accreditation bodies such as the Australian Commission on Safety and Quality in Health Care (ACSQHC) and the Australian Medical Council (AMC) are adjusting their standards to encourage improved work and training practices.

The acrimonious road to the 48 hour week

With the next contractual era for junior doctors around the corner, Adam Moreton considers the journey so far to reduce junior doctors’ working hours

Seven nights in row to end for junior doctors in Scotland, government says

Junior doctors in Scotland will no longer work seven full night shifts in a row, the Scottish government has said. In a letter to NHS health boards, Paul Grey, chief executive of NHS Scotland, set out several initiatives to reduce junior doctors’ working hours. The letter said that NHS boards will by February 2015 end the practice of rostering junior doctors for seven full night shifts in a row. It said that boards will simplify the process for monitoring working hours and review rotas with a view to …

Have restricted working hours reduced junior doctors’ experience of fatigue? A focus group and telephone interview study

ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors’ experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors...

Working time restrictions may have increased tensions between trainees and consultants, studies find

European restrictions on working hours may have increased tensions between junior doctors and their senior colleagues, researchers have found. Two studies published on BMJ Open showed that doctors saw restrictions on working hours as having reduced junior doctors’ time in training and increased the work carried out by consultants. But the researchers behind the studies said that it was difficult to determine whether doctors’ concerns stemmed from the restrictions themselves or the way that hospitals had implemented them. One study was a qualitative analysis of 279 unsolicited free text comments about the European Working Time Directive (EWTD).1 The responses—from 1993, 2005, and 2009—were made by three groups of UK medical graduates as part of a wider survey of doctors’ training and career choices. This study found that the reduction in junior doctors’ time in training and the increase in work for senior doctors may have created tensions between the two groups. “Some consultants indicated that they felt beleaguered by carrying some of …

Improving the quality of care for medical inpatients by placing a higher priority on ward rounds

Models suggested for managing acute, non-elective, medical admissions include expanding geriatric services, extending the role of the acute physician and rejuvenating the role of the general physician. We investigated improving inpatient care by changing consultants’ work patterns and placing a higher priority on the ward rounds. A focus group and a questionnaire were used to study the impact on several ward round parameters. All respondents reported an overall satisfaction: 93% rated the quality of care as good or excellent, 75% reported increased safe patient discharges and 68% observed improved teamwork. Length of stay reduced to 4 days from 5.3 days without an increase in readmission. The main themes showed improved quality of care, better assured patients and relatives, and better consultant job satisfaction, but also showed reduced junior doctors’ independent decision-making and a slight reduction in specialty-related activity. The study concluded that placing a higher priority on ward rounds by altering consultants’ work patterns has a positive impact on inpatient care.

P97 Development of the advanced nurse practitioner role in hospice care: A medical model

Background/ContextThe role of the Advanced Nurse Practitioner (ANP) encompasses the provision of advanced levels of clinical practice, knowledge and skills. Whilst involving aspects of education and research, it is firmly...

Finished Core Training but not 'Registrar Ready'? Making a Case for a Third Year of Core Surgical Training

The implementation of the european Working time regulations in 1993 saw the reduction of junior doctors' working hours from 72 hours to 48 hours per week. While this is argued to be a safeguard for patient and doctor health, these reforms have resulted in a drastic reduction in obligatory training and have been the subject of much scrutiny, including from the royal college of surgeons of england.

Hours and pay of doctors in training: an update

British Journal of Hospital MedicineVol. 74, No. Sup2 What they Don't teach you in Medical SchoolHours and pay of doctors in training: an updateRachel HookeRachel HookeSearch for more papers by this authorRachel HookePublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2013.74.Sup2.C31AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References EWTD Reference Group (2009) A guide to the implications of the European Working Time Directive for doctors in training. www.dh.gov.uk/rod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_110097.pdf (accessed 4 September 2012) Google ScholarHooke R (2000) The role of task force junior doctor BMJ Nov 4; Suppl 2–3 [Career Focus] Crossref, Google ScholarHooke R (2007) Junior doctors’ hours and pay: a guide for foundation year doctors. Br J Hosp Med 68(3): M38–9 Link, Google ScholarNHS Management Executive (1991) Junior doctors. The new deal. NHS Executive, London Google ScholarFurther readingDepartment of Health (1998) HSC 1998/240: Reducing junior doctors’ hours continuing action to meet new deal standards rest periods and working arrangements, improving catering and accommodation for juniors, other action points. Health Service Circular 1998/240. www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4003928 (accessed 23 November 2012) Google ScholarDepartment of Health (2000a) Junior doctors contract: Part A - General guide to the new pay system; Part B - Definitions. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009033 (accessed 23 November 2012) Google ScholarDepartment of Health (2000b) Junior Doctors’ Hours – Monitoring Guidance. www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4053882.pdf (accessed 23 November 2012) Google Scholar FiguresReferencesRelatedDetailsCited byHow to deal effectively with human resources departments28 March 2014 | British Journal of Hospital Medicine, Vol. 75, No. Sup1 1 February 2013Volume 74Issue Sup2ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 February 2013 Information© MA Healthcare LimitedPDF download

Fracture clinic redesign: improving standards in patient care and interprofessional education

Current fracture clinic models, especially with the advent of reductions in junior doctors' hours, may limit outpatient trainee education and patient care. We have designed a new fracture clinic model, involving an initial consultant-led case review focused on patient management and trainee education. Prospective outcomes for all new patients attending the redesigned fracture clinic over a 3-week period in 2010 (n = 240) were compared with a historical cohort from the same period in 2009 (n = 296). The primary outcome measure was the proportion of patients with direct consultant input. Secondary outcome measures included patient discharge rates, return rates, use of the nurse-led fracture clinic and the incidence of adverse event reporting. Trainees attending each clinic completed a five-point Likert questionnaire assessing the adequacy of education, support, staff morale and standards of patient care, before and after introduction of the clinic redesign. Using a separate Likert questionnaire, emergency room (ER) staff were evaluated to determine the impact of the new style clinic on their education, daily practice and interprofessional relations. Adverse events were gathered from the 'incident record 1' (IR1) reporting system. The percentage of cases given consultant input increased significantly from 33% in 2009 to 84% in 2010 (p <0.0001), while the proportion of patients requiring physical review by a consultant fell by 21% (p <0.0001). Return rates were reduced by 14% (p = 0.013) and use of the nurse-led fracture clinic improved by 10% (p = 0.0028). There was a median improvement in trainee perception of education from 2 (interquartile range 1.25-2.75) to 5 (4.25-5, p = 0.011), senior support from 2 (2-3) to 5 (4-5, p = 0.017) and patient care from 3 (3-4) to 5 (4-5, p = 0.015). ER staff found the new style clinic was educational, practice changing and improved interprofessional relations, but that it did not interfere with ER duties. The incidence of adverse incidents reported fell from 8 per year to 0 per year after the introduction of the new style clinic. Our model of fracture-clinic redesign has significantly enhanced consultant input into patient care without additional funding. In addition, we have demonstrated increased service efficiency and significant improvements in staff support, morale and education. In the face of current economic and training challenges, we recommend this new model as a tool that will enhance patient and trainee experience.

Editorial: How nurses can support the Surviving Sepsis Campaign

Editorial: How nurses can support the Surviving Sepsis Campaign

Improving the efficiency of the emergency general surgical service

To improve the quality and efficiency of our emergency surgical service. Until 2007, the surgical on-call in our unit was run on a 'consultant of the day' model with triage in a 10-bed surgical receiving unit (SRU) before admission to the wards. The reduction in junior doctors' hours meant little continuity and delays in care.In July 2007, the SRU was expanded and a daily on-ward ultrasound session was established. The consultant rota was changed to a split-week model with twice-daily SRU ward rounds, allowing unstable patients regular senior assessment. As a result of the change, our acute length of stay reduced from 4.4 to 3.8 days and our actual versus expected length of stay was the best figure country-wide. Early consultant review and swift ultrasound assessment reduce admissions and patient stay. We have combined these factors in our emergency service and have delivered significant cost savings and improved care.

Interns' attitudes to IV cannulation: a KAP study

One of the most common procedures for junior medical doctors is peripheral intravenous cannulation (PIVC). Considering this, an understanding of the peripheral intravenous cannulation procedure is paramount. The objective of this study was to identify the level of understanding of interns regarding intravenous cannulation. An anonymized structured questionnaire using a knowledge attitude and practices (KAP) format was distributed to 60 interns affiliated to a university college hospital in Ireland. This study suggests that interns are poorly prepared for one of the most common clinical skills they will perform. They showed poor understanding of whether peripheral cannulation is a clean or aseptic technique, and lacked knowledge of the potential side effects of peripheral cannulation and IV therapy. A structured learning module on peripheral intravenous cannulation is required. A rigid, evidence-based, Objective Structured Clinical Examination (OSCE) on peripheral cannulation is recommended. The reduction of junior doctors' weekly working hours to 48 under the European Working Time Directive offers the potential for nurses to take ownership of IV cannulation. This will allow junior doctors to focus on other clinical skills and assessments, which can only be to the advantage of the patient.

Interns' attitudes to IV cannulation: a KAP study

One of the most common procedures for junior medical doctors is peripheral intravenous cannulation (PIVC). Considering this, an understanding of the peripheral intravenous cannulation procedure is paramount. Aim: The objective of this study was to identify the level of understanding of interns regarding intravenous cannulation. Method: An anonymized structured questionnaire using a knowledge attitude and practices (KAP) format was distributed to 60 interns affiliated to a university college hospital in Ireland. Findings: This study suggests that interns are poorly prepared for one of the most common clinical skills they will perform. They showed poor understanding of whether peripheral cannulation is a clean or aseptic technique, and lacked knowledge of the potential side effects of peripheral cannulation and IV therapy. Recommendations: A structured learning module on peripheral intravenous cannulation is required. A rigid, evidence-based, Objective Structured Clinical Examination (OSCE) on peripheral cannulation is recommended. The reduction of junior doctors’ weekly working hours to 48 under the European Working Time Directive offers the potential for nurses to take ownership of IV cannulation. This will allow junior doctors to focus on other clinical skills and assessments, which can only be to the advantage of the patient.

Simulation in obstetrics and gynaecology

Simulation is a hot topic in 21st century medical education but is not a new phenomenon. It is hailed as a potential solution to the reduction in junior doctors’ working hours and the resulting reduction in their hands on experience. However, simulation is just one of many educational tools and will never replace the actual clinical workplace. Neither is it new to medical training. Role-play is a form of simulation, albeit not along the same lines as that is encountered with a high fidelity, high-price tag manikin, but nonetheless is an important element of rehearsal that perhaps we have chosen to disregard needlessly in place of technology. Medical school curriculae still rely heavily on roleplay as part of teaching and assessment. OSCEs and drills on labour wards have always been low-tech but very effective forms of simulation and have certainly endured the test of time. Part-task trainers and medium fidelity manikins are now recreating all manner of emergencies as technology advances. It is possible to reenact delivery with certain models and provide essential training in the team management of realistic haemorrhage including using a wireless model to take the scenarios from the delivery suite to the operating theatre where preparation can be made for surgery. This allows both rehearsal of these essential team-working patterns and gives opportunities for each member of the team to gain perspective on the limitations as well as the unrealized potential in others during critical situations.