920 Improving the Management of Post-Operative Hypocalcaemia In Thyroid Surgery

Abstract Aim Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2] due to the removal of the parathyroid glands. This quality improvement (QI) project was undertaken in a large Ear, Nose and Throat department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method A baseline audit was conducted to determine initial guideline compliance. The QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

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37 Improving the Management of Post-Operative Hypocalcaemia in Thyroid Surgery

British Journal of Surgery ◽

10.1093/bjs/znab134.350 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Collins ◽

G Lafford ◽

R Ferris ◽

J Turner ◽

P Tassone

Keyword(s):

Patient Safety ◽

Junior Doctor ◽

Junior Doctors ◽

Intermediate Risk ◽

Inpatient Stay ◽

Calcium Supplements ◽

Appropriate Prescribing ◽

Intraoperative Pth ◽

Patients At Risk ◽

Patient Handover

Abstract Introduction Hypocalcaemia is a frequent, and potentially dangerous, complication of total thyroidectomy [1, 2]. This quality improvement (QI) project was undertaken in a large ENT department in the East of England over a year. The project improved postoperative guideline compliance by optimising the recognition and management of patients at risk of hypocalcaemia. This process focussed on improving parathyroid hormone (PTH) and calcium blood testing, appropriate prescribing and the monitoring and management of hypocalcaemia. Method Following a baseline audit the QI process subsequently involved the introduction of a new intraoperative PTH pathway and the amendment of trust guidelines. In addition, there was a focus on improving clinician awareness of guidelines, junior doctor education, communication between operating surgeons and junior doctors and the optimisation of patient handover. Results The measurement of PTH at four hours improved from 42.5% to 52.2%. The project saw a significant improvement in the monitoring of hypocalcaemia (from 22.2% to 83.3% for patients with an intermediate risk of hypocalcaemia) and in the prescribing of prophylactic calcium supplements from 7.5% to 43.5%. Conclusions By optimising postoperative care this QI project improved patient safety as well as impacting on the duration, and overall cost, of inpatient stay.

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Analysis of adequacy in prescribing calcium supplements based on the daily dairy intake in patients at risk of osteoporosis

Bone Abstracts ◽

10.1530/boneabs.3.pp329 ◽

2014 ◽

Author(s):

Carlos Gomez ◽

Ana Gomez-Hernandez ◽

Sonia Sanchez ◽

Samuel Saez ◽

Angeles Gonzalez-Carcedo ◽

...

Keyword(s):

At Risk ◽

Calcium Supplements ◽

Dairy Intake ◽

Patients At Risk

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

The Journal of Mental Health Training Education and Practice ◽

10.1108/jmhtep-06-2015-0026 ◽

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.

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Near-misses and Missed Opportunities: Poor Patient Handover In General Surgery

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363508x273533 ◽

2008 ◽

Vol 90 (3) ◽

pp. 96-98 ◽

Cited By ~ 6

Author(s):

M Tokode ◽

L Barthelmes ◽

B O'Riordan

Keyword(s):

General Surgery ◽

Working Hours ◽

Junior Doctors ◽

Learning Potential ◽

Missed Opportunities ◽

Near Misses ◽

Medical Careers ◽

European Working ◽

Working Time Directive ◽

Patient Handover

Since the introduction of shift systems for junior doctors as part of the European Working Time Directive, different teams of doctors look after patients over the course of a day. This requires ro bust handover mechanisms to pass on inf ormation between differ ent teams of doctors to avoid misses and near-misses in patients' care. Modernising Medical Careers shortens the placements of doctors in foundation programmes in general surgery to four months compared with six-month placements as pre-registration house officers in the past. The reduction in working hours will therefore adv ersely aff ect exposur e and experience of junior doctors in general surg ery unless the learning potential of time spent at work is maximised.

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The changing role of the otolaryngology Senior House Officer

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363506x78992 ◽

2006 ◽

Vol 88 (2) ◽

pp. 66-68 ◽

Cited By ~ 1

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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Reducing potentially avoidable tasks in a hyperacute stroke unit

BMJ Open Quality ◽

10.1136/bmjoq-2021-001482 ◽

2021 ◽

Vol 10 (3) ◽

pp. e001482

Author(s):

Derya Tireli ◽

Michael Broksgaard Jensen

Keyword(s):

Stroke Unit ◽

Junior Doctor ◽

Night Shift ◽

Healthcare Providers ◽

Junior Doctors ◽

Patient Admissions ◽

Work Routines ◽

Routine Tasks ◽

Very High ◽

Night Shifts

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 and intensive care is not. The specialised and standardised settings in a stroke regime are constant and demanding for healthcare providers who, therefore, must work efficiently. Patient admissions, acute situations and routine tasks are major contributors to the burden of work during evening and night shifts for junior doctors on call. Thus, it is important to reduce the number of potentially avoidable tasks done by these junior doctors during night shifts so they have more time to perform tasks of high priority. The aim of this project was to reduce the potentially avoidable tasks occurring at night for the on-call junior doctor to only one per shift. We investigated the types of tasks that frequently occur for the on-call junior doctor during the night shift and improved our daily morning and evening rounds to reduce the number of tasks during the night shift. Using the plan–do–study–act method, we made improvements through education, knowledge sharing, checklists and feedback, and we reduced the number of potentially avoidable tasks for on-call junior doctors from a median of 11 to a median of 3 per week, demonstrating that the workload for the on-call junior doctor during the night shift can be reduced through a systematic approach to improving the work routines of doctors and nurses.

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The EWTD: friend or foe to quality patient care?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363506x148183 ◽

2006 ◽

Vol 88 (9) ◽

pp. 318-319

Author(s):

MBS Brewster ◽

R Potter ◽

D Power ◽

V Rajaratnam ◽

PB Pynsent

Keyword(s):

Patient Care ◽

Medical Staff ◽

Junior Doctor ◽

European Working Time Directive ◽

Junior Doctors ◽

Out Of Hours ◽

Quality Patient Care ◽

European Working ◽

The Uk ◽

Working Time Directive

For the last few years all the hospitals in the UK have been changing junior doctors' rotas to become compliant with the European Working Time Directive (EWTD). The first stage, requiring a junior doctor to work a maximum of 58 hours per week averaged over a 6-month period, became law in August 2004. In addition to new posts for junior doctors there have been schemes to facilitate the transition, such as the Hospital at Night programme. This was designed to use the minimum safe number of doctors from appropriate specialties with supporting medical staff to cover the hospital out of hours. It was required to make the most efficient use of this team and allow the junior doctor rotas to be compliant with the appointment of as few new posts as possible.

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Redesigning the psychiatry induction

BJPsych Open ◽

10.1192/bjo.2021.450 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S162-S162

Author(s):

Sharadha Wisidagama ◽

Martin Schmidt

Keyword(s):

Junior Doctor ◽

General Medical Council ◽

Electronic Record ◽

Junior Doctors ◽

Medical Council ◽

Education Department ◽

Record System ◽

Training Requirements ◽

Regulatory Bodies ◽

Service Gap

AimsTo analyse the current psychiatry induction programme with regards to national guidance, local requirements, trainee and trainer feedback and implement recommendations to streamline where possible.BackgroundJunior doctors in training rotate every 4 or 6 months depending on the grade/programme group. GP and FY trainees are often new to psychiatry therefore require a comprehensive induction.Our Trust has had a three day induction for new junior doctors comprised of 1 day Corporate Induction, 1 day Electronic Records Training and 1 day Local induction.During the 3 day induction programme there is often a service gap with covering out of hours and acute services. Trainees and trainers have expressed concern regarding the service gap.We therefore embarked on a review of the induction programme to investigate whether it could be improved in content and length of time to deliver.MethodReview the regulatory bodies requirements for junior doctor induction.Gain an understanding of the trainees and trainers perspective of the induction programme.Review the items in the induction programme according to the requirements of the regulatory bodies.Tailor the induction programme for junior doctors’ needs whilst complying with the regulatory bodies requirements.ResultThe General Medical Council (GMC), British Medical Association (BMA), Gold Guide, Health Education England (HEE) and National Health Service (NHS) employment have no specific statutory and mandatory training requirements for induction.The regulatory bodies have generic standards for junior doctor induction.Induction is the responsibility of the Trust.Trainee perspective: Electronic record system, Mental Health Act (MHA) and pharmacy training were agreed as needing review in terms of its content and length.Trainees also requested extra items to be included in the induction programme to support successful transition in to their work placements.The education department met with the Digital Team, MHA Team and Pharmacy Team to develop new and more relevant course content and add in the requested items.The new induction programme was launched in December 2019 and was reduced in length from 3 to 2 and a half days. Trainee satisfaction improved as evidence by trainee feedback.ConclusionThe review was helpful in establishing the requirements for a good induction and highlighting areas for improvement.The new induction was more focussed, shorter in duration and had improved trainee feedback.The Medical Education Department will assess the changes following the December 2019 induction and continue to review its induction programme.

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An audit cycle of consent form completion: A useful tool to improve junior doctor training

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.182246 ◽

2016 ◽

Vol 49 (01) ◽

pp. 72-75 ◽

Cited By ~ 1

Author(s):

Catherine Leng ◽

Kavita Sharma

Keyword(s):

Junior Doctor ◽

General Medical Council ◽

Consent Form ◽

Junior Doctors ◽

Medical Council ◽

Emergency Setting ◽

Consent Forms ◽

Surgical Practice ◽

Audit Cycle ◽

Practice Methods

ABSTRACT Background: Consent for surgical procedures is an essential part of the patient's pathway. Junior doctors are often expected to do this, especially in the emergency setting. As a result, the aim of our audit was to assess our practice in consenting and institute changes within our department to maintain best medical practice. Methods: An audit of consent form completion was conducted in March 2013. Standards were taken from Good Surgical Practice (2008) and General Medical Council guidelines. Inclusion of consent teaching at a formal consultant delivered orientation programme was then instituted. A re-audit was completed to reassess compliance. Results: Thirty-seven consent forms were analysed. The re-audit demonstrated an improvement in documentation of benefits (91–100%) and additional procedures (0–7.5%). Additional areas for improvement such as offering a copy of the consent form to the patient and confirmation of consent if a delay occurred between consenting and the procedure were identified. Conclusion: The re-audit demonstrated an improvement in the consent process. It also identified new areas of emphasis that were addressed in formal teaching sessions. The audit cycle can be a useful tool in monitoring, assessing and improving clinical practice to ensure the provision of best patient care.

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