scholarly journals 88 Improving Clinical Effectiveness At Identifying Patients Requiring Advanced Care Plans

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
P Nemchand ◽  
D Hassan ◽  
A Steel
Keyword(s):  
Junior Doctor ◽  
Positive Impact ◽  
Clinical Effectiveness ◽  
District General Hospital ◽  
Junior Doctors ◽  
Advanced Care Planning ◽  
Team Members ◽  
Care Plans ◽  
White Boards ◽  
Geriatric Inpatients

Abstract Our project was conducted in a district general hospital across five acute geriatric wards. Our team included consultants, registrars, and ward matrons. The project focused on improvement of care for geriatric inpatients, with moderate to severe frailty. Advanced care planning (ACP) columns are displayed on white boards. They indicate whether ACPs are required/initiated for each patient. When previously utilised, ACPs were initiated for 78% of appropriate patients [1]. Following a change in staff and reduction in awareness/education, the ACP column use reduced with fewer ACPs established. Our goals were to ensure completion of the ACP column, encourage junior doctor/nurse involvement and trigger a greater number of appropriate ACPs initiated Improvement in ACP practice was addressed by daily board round review of appropriate patients for ACP, increasing awareness of ACP triggers and education around discussion content. Interventions consisted of: 1, a flow-chart adjacent to white boards prompting “Do not attempt resuscitation (DNAR)” and ACP processes. This signposted staff to information on ACP triggers and “how to start a conversation”. 2 Involving registrar “champions” on each ward. We explained our intervention to all team members to encourage engagement. Data from the ACP columns were audited prior to intervention, 2 weeks and 6 weeks after intervention. There was a 54% increase in ACP documentation after 6 weeks across the wards. The improvement in the use of the ACP column correlated with a greater number of ACPs initiated. This facilitated an increase in consideration of patient wishes towards the end of life. Increasing use of a daily ACP prompts on board rounds triggers an increase in ACP implementation for appropriate patients. Sustainability was achieved by recruitment of ward “ACP champions”. Junior doctors/matrons were more empowered to discuss ACPs. Results were presented at departmental teaching to reinforce the positive impact of the intervention.

scholarly journals Escalation of care planning on an older adult inpatient unit during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S90-S91
Author(s):  
Alexander McDermott ◽  
Jennifer Rankin
Keyword(s):  
Older Adult ◽  
District General Hospital ◽  
Junior Doctors ◽  
Best Interest ◽  
Sustained Improvement ◽  
Difficult Decision ◽  
Care Plans ◽  
Risks And Benefits ◽  
Pdsa Cycle ◽  
Adult Inpatient

AimsInitial planning during the first wave of the COVID-19 pandemic involved difficult decision making for many clinicians. The Older Adult Mental Health Wards in Bridgend were relocated from the district general hospital (Princess of Wales) and merged at Angelton Clinic, an off site separate unit. It was therefore essential that patients had clear escalation of care plans as access to medical input was limited and transfer to hospital potentially not appropriate in the later stages of chronic illness such as dementia.The initial aim of the PDSA cycle was to assess the level of compliance with Do Not Attempt Resuscitation (DNAR) discussions and if appropriate, DNAR documentation. The other aim was to assess the utilisation of Escalation of Care plans.MethodAn audit of patients MDT medical notes on 38 admitted to Angelton clinic was carrired out in March. It was documented if the patient had a clear DNAR or Escalation plan that was easily accessible in the front of the notes. The guidelines compared to were the GMC recommendations that patients 12 months of should have a discussion about risks and benefits associated with Cardiopulmonary Resuscitation. If the patient lacks capacity a best interest decision should be made with nearest relatives. Discussions should also be had with patients and family in in regards to and transfer to a medical ward.Upon completion of the initial PDSA cycle, views were sought from the wider MDT a new escalation of care proforma was designed. This was implemented by education and communication with members of the medical team. This was to be clearly placed in the notes, with the DNAR form if that was appropriate.ResultAll inpatient notes were audited at Angelton Clinic in March 2020. It was found that only 18% of patients had Escalation of Care plans in comparison to 84% of notes which had DNAR forms. Previous escalation of care forms were not being utilised appropriately.Upon implementation of the Escalation of Care proforma, a re-audit of the audit cyle was completed. In July 2020 it was found that 78% of notes had completed Escalation of Care forms with 83% had completed DNAR forms.ConclusionTo enable ongoing sustained improvement, the unit Nurse Practitioner will champion its completion. The audit findings have been shared with the newly rotated junior doctors and proformas were made available on all inpatient wards.

scholarly journals Junior doctor-led quality improvement project to improve safety and visibility of an interspecialty referral system

2021 ◽  
Vol 10 (3) ◽  
pp. e001323
Author(s):  
Dowan Kwon ◽  
Won Young Moon ◽  
Michelle Akhunbay-Fudge ◽  
Brandon Pieters ◽  
Jeni Pillai ◽  
...  
Keyword(s):  
Cultural Change ◽  
District General Hospital ◽  
Electronic Record ◽  
Referral System ◽  
Junior Doctors ◽  
Electronic Patient Records ◽  
Improvement Project ◽  
Team Members ◽  
Stakeholder Satisfaction ◽  
Qualitative Feedback

Interspecialty referrals for increasingly complex hospital inpatients are common and miscommunication often leads to delays in patient care. In a district general hospital, a web-based system generated an email referral, which lacked visibility and tracking/audit of the process, with no record generated automatically in paper inpatient notes or electronic patient records (EPR). We aimed to improve the visibility and safety of the interspecialty referral system.We canvassed stakeholders, informally and via an online satisfaction survey, collecting qualitative and quantitative data about attitudes to the existing system, generating ideas for change. We process mapped the system, identifying points of weakness. We adapted our EPR system, using a work-around solution, to develop a form that could be emailed from the EPR. This generated a permanent record within the EPR and an electronic record of the referral having been sent. We measured the visibility of referrals and responses within the EPR. We generated an online training ‘how-to’ video and reaudited stakeholder satisfaction.There was a significant increase in the proportion of junior doctors satisfied or very satisfied with the interspecialty referral system (27/31 postintervention; 87.1% vs 26/55 preintervention; 47%; p<0.0001) and more believed that the visibility was adequate or very adequate (24/31 postintervention; 77.4% vs 9/55 preintervention; 16.4%; p<0.0001). Visibility of referrals by project team members on the EPR increased from a baseline of 3.5% to 83.6% and the visibility of responses to these referrals on the EPR increased from 4.6% to 40.7%. Qualitative feedback was excellent, hospital executive approval was gained and our work-around system spread to non-team members.We developed a more visible and reliable interspecialty referral system, adapting existing EPR capabilities, which was popular with users and led to cultural change in interspecialty referral responders. A formal EPR redesign, informed by our project, is in development.

Quantitative and qualitative analysis of exception reporting at a district general hospital

2021 ◽  
pp. 1-10
Author(s):  
Charlotte G Underwood ◽  
Qamrunnisa U Yunus ◽  
Alexander B Gibson
Keyword(s):  
Qualitative Analysis ◽  
General Hospital ◽  
Junior Doctor ◽  
District General Hospital ◽  
Junior Doctors ◽  
Educational Issue ◽  
Common Response ◽  
Hours Of Work ◽  
Exception Reporting ◽  
Work Done

Background/aims Exception reporting is a function by which junior doctors report when their work has varied from expected. This study analysed the reporting at the authors' hospital. Methods The authors analysed 204 reports submitted across 12 months to investigate the nature and pattern of the exception reports. Results The majority of reports (86%) were for ‘hours and rest’, 5% for education and 9% for both. On average doctors reported an additional 1.32 hours of work per report. The most common response was time off in lieu, but 13% of reports were never responded to. Qualitative analysis showed the most common reasons for reporting were ‘work outside of rostered hours’, ‘workload’ and ‘staffing issues’. Over 10% of the reports discussed an educational issue. Conclusions The data were not specific and there was fewer than one report per junior doctor in the period analysed. It is therefore unlikely that the reports submitted represent the additional work done by junior doctors at the hospital. Guardians should investigate local attitudes to exception reporting and educate both seniors and juniors on the importance of submitting accurate exception reports.

scholarly journals 145 Point of care lung ultrasound in patient triage: integration of ultrasound into a streaming pathway for COVID-19

2020 ◽  
Vol 37 (12) ◽  
pp. 839.1-839
Author(s):  
Dominic Craver ◽  
Aminah Ahmad ◽  
Anna Colclough
Keyword(s):  
Point Of Care ◽  
District General Hospital ◽  
Training Programme ◽  
Service Evaluation ◽  
University Hospital ◽  
Junior Doctors ◽  
Point Of Care Ultrasound ◽  
Face To Face ◽  
Point Of Care Diagnostics ◽  
Audit Data

Aims/Objectives/BackgroundRapid risk stratification of patients is vital for Emergency Department (ED) streaming during the COVID-19 pandemic. Ideally, patients should be split into red (suspected/confirmed COVID-19) and green (non COVID-19) zones in order to minimise the risk of patient-to-patient and patient-to-staff transmission. A robust yet rapid streaming system combining clinician impression with point-of-care diagnostics is therefore necessary.Point of care ultrasound (POCUS) findings in COVID-19 have been shown to correlate well with computed tomography (CT) findings, and it therefore has value as a front-door diagnostic tool. At University Hospital Lewisham (a district general hospital in south London), we recognised the value of early POCUS and its potential for use in patient streaming.Methods/DesignWe developed a training programme, ‘POCUS for COVID’ and subsequently integrated POCUS into streaming of our ED patients. The training involved Zoom lectures, a face to face practical, a 10 scan sign off process followed by a final triggered assessment. Patient outcomes were reviewed in conjunction with their scan reports.Results/ConclusionsCurrently, we have 21 ED junior doctors performing ultrasound scans independently, and all patients presenting to our department are scanned either in triage or in the ambulance. A combination of clinical judgement and scan findings are used to stream the patient to an appropriate area.Service evaluation with analysis of audit data has found our streaming to be 94% sensitive and 79% specific as an indicator of COVID 19. Further analysis is ongoing.Here we present both the structure of our training programme and our integrated streaming pathway along with preliminary analysis results.

scholarly journals Exploring the Relationship between Communication and Success of Construction Projects: The Mediating Role of Conflict

2021 ◽  
Vol 13 (8) ◽  
pp. 4513
Author(s):  
Summaira Malik ◽  
Muhammad Taqi ◽  
José Moleiro Martins ◽  
Mário Nuno Mata ◽  
João Manuel Pereira ◽  
...  
Keyword(s):  
Project Success ◽  
Negative Impact ◽  
Positive Impact ◽  
Construction Project ◽  
Project Team ◽  
Relationship Conflict ◽  
Team Members ◽  
Mediating Role ◽  
The Impact

The success of a construction project is a widely discussed topic, even today, and there exists a difference of opinion. The impact of communication and conflict on project success is an important, but least addressed, issue in literature, especially in the case of underdeveloped countries. Miscommunication and conflict not only hinder the success of a project but also may lead to conflicts. The focus of this paper was to examine the impact of communication on project success with the mediating role of conflict. By using SPSS, demographics, descriptive statistics and correlation were determined. Smart PLS version 3.0 was used for confirmatory factor analysis (CFA), internal accuracy and validity estimates, hypothesis checking and mediation testing. The results showed that formal communication has a negative impact on the success of a construction project, resulting in conflicts among project team members, whereas informal communication and communication willingness have a positive impact on project success because people tend to know each other, and trust is developed. Task, process and relationship conflicts were used as mediating variables. It was found that task conflict effects the relations positively because project team members suggest different ways to do a certain task, and, hence, project success is achieved. On the contrary, process conflict and relationship conflict have a negative impact on communication and project success. Both of these conflicts lead to miscommunication, and project success is compromised. Hence, it is the responsibility of the project manager to enhance communication among project team members and to reduce the detrimental effects of process and relationship conflict on project success.

scholarly journals A Multidisciplinary Approach to Implement Personalized Breast Cancer Treatment and Care Plans

2021 ◽  
Vol 28 (1) ◽  
pp. 767-782
Author(s):  
Rashida Haq ◽  
Amy Kong ◽  
Pauline Gulasingam
Keyword(s):  
Breast Cancer ◽  
Primary Care Physicians ◽  
Phase 1 ◽  
Data Entry ◽  
Implementation Process ◽  
Standard Of Care ◽  
Care Team ◽  
Quality Improvement Initiative ◽  
Team Members ◽  
Care Plans

Implementation of survivorship care plans remain a challenge. This quality improvement initiative aims to integrate personalized treatment plans (PTP) and care plans (PCP) into the existing workflow for breast cancer (BC) patients. Methods: Phase 1 was to identify multidisciplinary team members to generate and deliver PTP and PCP. Concurrently, Phase 2 was to deliver PTP and PCP to newly diagnosed invasive BC patients at chemotherapy initiation and completion, respectively. Iterative plan, do, study, act (PDSA) cycles were applied to refine the process. The proportion of information completed for PTP and PCP generation and its delivery by the care team were measured. Patient and provider satisfaction were also assessed. Implementation Process and Results: The care transfer facilitator (CTF) was identified to complete and deliver PTP, and their data entry increased from 0% to 76%, 80%, 92% consecutively during the last 4 PDSA cycles. PTP and PCP were provided to 85% of eligible BC patients. Patients agreed that PTP helped them to actively participate in their care (88%) and communicate with the oncology care team (86%). Primary care physicians agreed that PTP and PCP had the information needed to “stay in the loop” (80%), and oncologists agreed they should be incorporated into oncology clinics (100%). Conclusions: Integrating PTP and PCP generation and delivery into existing workflow has led to an increase in uptake, sustainability and provider buy-in. With limited resources, it remains difficult to find care team members to complete the forms. A dedicated personnel or survivorship clinic is required to successfully implement PTP and PCP as the standard of care.

Recruitment into forensic psychiatry, a cross sectional survey to identify attitudes and opinions of core trainees of this speciality

2016 ◽  
Vol 11 (3) ◽  
pp. 144-155
Author(s):  
Kassia Lowe ◽  
Fiona Hynes
Keyword(s):  
Forensic Psychiatry ◽  
Junior Doctor ◽  
Response Rate ◽  
Current Trend ◽  
Junior Doctors ◽  
Cross Sectional Survey ◽  
Content Type ◽  
Post Graduate ◽  
Short Statement ◽  
The Impact

Purpose – The purpose of this paper is to address and understand recruitment difficulties into psychiatry; however, to date there is no published research with respect to forensic psychiatry. Forensic psychiatry has always been considered to be a popular specialty amongst junior doctors and therefore the recent trend in local unfilled core training (CT) (junior doctor) posts and national reduced competition ratios for higher specialist training has triggered concern. The impact vacant CT posts within the Forensic Service may have on the future workforce must be considered. Further understanding of this trend is required. Design/methodology/approach – A short statement-style survey addressing attitudes and opinions with respect to the field of forensic psychiatry was devised and distributed to all West Midlands core psychiatry trainees who attended post-graduate teaching (November 2014). Findings – Response rate was 64 per cent. In total, 52 per cent of participants expressed an interest in the specialty, but only 13 per cent wished to pursue a career in forensic psychiatry. In total, 68 per cent of responses deemed forensic psychiatry to be a demanding speciality, with over 50 per cent perceiving forensic patients as difficult to work with. There were high rates of uncertain responses with respect to specialty work life. In total, 78 per cent of responses considered experience of the specialty to be useful. Research limitations/implications – The method chosen to distribute the survey maximised response rate, but may have introduced a Hawthorne effect, as well as response bias, with the visual presence of the researcher. Participants were limited to those who attended teaching on the specified day. This could potentially skew results with an absence of opinions of non-attenders. It may be that characteristics and therefore attitudes and opinions of these two groups are different. A further limitation of the study is that opinions explored are limited to statements included within the survey. Practical implications – The current views may represent stigma, negative media portrayal and misinformed opinions. Action must be taken to increase understanding, interest and experience. Increased exposure to the specialty needs to occur. This could occur as early as high school, using case-study exercises and career sessions. Teaching sessions, summer school placements and elective opportunities should be made available for medical students. At post-graduate level, taster days as well as earlier access to rotations may be a way forward. Originality/value – Although entry into Forensic Higher Training remains comparatively competitive, the potential impact of vacant junior doctor (CT) posts within the speciality is concerning. This is likely to negatively influence recruitment into higher training, which may ultimately lead to decreased numbers of qualified forensic psychiatrists. Specialised care for such a risky and challenging patient group could thus be significantly compromised in the near future. Hence, it is vital to understand the current trend in order to act pre-emptively and address the underlying problems. To date no such research has been conducted.

Positive Impact of Internet-based Survivorship Care Plans on Healthcare and Lifestyle Behaviors

2012 ◽  
Vol 84 (3) ◽  
pp. S211-S212 ◽  
Author(s):  
C. Hill-Kayser ◽  
C. Vachani ◽  
M. Hampshire ◽  
G.A. Di Lullo ◽  
J.M. Metz
Keyword(s):  
Positive Impact ◽  
Survivorship Care Plans ◽  
Lifestyle Behaviors ◽  
Survivorship Care ◽  
Care Plans

How preferences for types of appreciation differ across employee age groups

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Paul White ◽  
Gene George
Keyword(s):  
Design Methodology ◽  
Positive Impact ◽  
Age Groups ◽  
Organizational Leaders ◽  
Human Resource Professionals ◽  
Content Type ◽  
Team Members ◽  
Older Employees ◽  
Post Hoc ◽  
Employee Age

Purpose Organizational leaders and human resource professionals affirm that to have (and keep) an effective workforce, understanding one’s employees is critical. Thus, understanding the differences between employees of different age groups is important. Simultaneously, studies have demonstrated the significant positive impact appreciation has on the functioning of organizations. When team members feel truly valued, numerous positive benefits result, including lower staff turnover, less absenteeism, higher customer ratings and greater profitability. Design/methodology/approach Because individuals prefer to be shown appreciation in different ways and prior research has shown some age differences, this study examined how appreciation preferences differ across seven employee age groups. Over 190,000 individuals completed an online assessment based on the five languages of appreciation, which identifies employees’ preferred ways of receiving appreciation. The respondents were separated into seven age groups, from 19 years old and younger to 70 years old and above. Findings The results of an analysis of variance found that there were significant differences across groups. Although the patterns of preferences were largely the same across many groups, post hoc analyses found both the youngest and oldest age groups differed from employees in their 30s with regards to their desire for quality time. Additionally, older employees were extremely low in their desire for tangible gifts. Originality/value As the proportion of employees shifts from older to younger groups of employees, these results raise important implications for organizations’ approaches regarding how appreciation and other motivators should be adjusted for different groups of employees.

The changing role of the otolaryngology Senior House Officer

2006 ◽  
Vol 88 (2) ◽  
pp. 66-68 ◽  
Author(s):  
AK Arya ◽  
KP Gibbin
Keyword(s):  
Patient Safety ◽  
Junior Doctor ◽  
House Officer ◽  
European Working Time Directive ◽  
Junior Doctors ◽  
Senior House Officer ◽  
European Working ◽  
Working Time Directive ◽  
Changing Role

The European Working Time Directive (EWTD) has led to a reduction in the number of hours that a junior doctor is allowed to work. The Hospital at Night project aims to reduce juniors' presence at night through more efficient working. Otolaryngology has been considered to be one of the surgical specialties in which generic junior doctors covering more than one specialty could effectively function. The hope is to reduce junior doctors' hours sufficiently without compromising their training or patient safety.

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