scholarly journals 939 Two Is Not Always Better Than One: A Quality Improvement Project Assessing Efficiency and Financial Implications Associated with Using Two Different Electronic Systems in A Busy Orthopaedic Department

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
V Kutuzov ◽  
H Shah ◽  
R Chaudhry ◽  
Y C Tan ◽  
D Nathwani
Keyword(s):  
Time Management ◽  
Financial Burden ◽  
Clinical Information ◽  
Junior Doctors ◽  
Electronic Systems ◽  
Hourly Wage ◽  
Improvement Project ◽  
Orthopaedic Department ◽  
Surgical Department ◽  
Local Trauma

Abstract Introduction Ensuring correct documentation and safe handover is key to the running of a successful surgical department. At Imperial College Healthcare Trust, this process has been made easier through various electronic systems available to our Orthopaedic department: our in-house CERNER system and out-of-house system eTrauma, the latter of which is predominantly used. The aim of this project was to assess our efficiency in terms of time management between the two systems, as well as financial implications of saved time. Method Multiple members of the Orthopaedic team timed themselves when entering information regarding a referral or an admission into both systems. This allowed us to estimate the financial implications of moving away from eTrauma. Results An average referral took 165 seconds (n = 27) to input information onto eTrauma, versus 38 seconds (n = 25) for CERNER. Time taken to document an admission was 127 seconds (n = 33) and 26 seconds (n = 31) respectively. The current hourly wage for our junior members is £22.84 per hour or 38p per minute. Moving away from eTrauma to CERNER will save around £1.50 for every 2 referrals and 2.5 admissions, solely from documentation. This is excluding the other benefits of CERNER, such as quick access to relevant clinical information, pathology results and imaging. Conclusions Leaving eTrauma behind will reduce the time spent on documentation by orthopaedic junior doctors. This will result in increased efficiency and will lessen the financial burden on an already overstretched budget. Our formal data will contribute to decision making and future resource allocation in our local Trauma and Orthopaedic Department.

261 Using Technology to Improve Inpatient Surgical Lists

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gowda ◽  
Z Chia ◽  
T Fonseka ◽  
K Smith ◽  
S Williams
Keyword(s):  
Quality Improvement ◽  
Patient Care ◽  
Junior Doctors ◽  
Research Projects ◽  
Point Scale ◽  
Improvement Project ◽  
Surgical Department ◽  
Team Meetings ◽  
And Training ◽  
Multi Disciplinary Team

Abstract Introduction Every day in our surgical department; prior to our quality improvement project, Junior Doctors spent on average 3.26 clinical hours maintaining 5 surgical inpatient lists of different specialities with accessibility of lists rated as “neutral” based on a 5-point scale from difficult to easy. Our hospital previously had lists stored locally on designated computers causing recurrent difficulties in accessing and editing these lists. Method We used surveys sent to clinicians to collect data. Cycle 1: Surgical Assessment Units list on Microsoft Teams Cycle 2: Addition of surgical specialities and wards lists onto Microsoft Teams. Cycle 3 (current): expand the use of Microsoft Teams to other specialities. Results Utilising technology led to a 25% reduction in time spent on maintaining inpatient lists, to 2.46 hours a day, and an improvement in the accessibility of lists to “easy”. Across a year, this saves over 220 hours clinician hours which can be used towards patient care and training. Furthermore, use of Microsoft Teams has improved communication and patient care, in the form of virtual regional Multi-Disciplinary Team meetings and research projects. Conclusions Microsoft Teams is currently free to all NHS organisations in England so there is potential for these efficiency savings to be replicated nationwide.

scholarly journals Improving knowledge and confidence in the acute management of eating disorders and resulting complications

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S186-S186
Author(s):  
Sarah Fynes-Clinton ◽  
Clare Price ◽  
Louisa Beckford ◽  
Maisha Shahjahan ◽  
Brendan McKeown
Keyword(s):  
Eating Disorders ◽  
Clinical Information ◽  
Easy Access ◽  
Average Score ◽  
Junior Doctors ◽  
Refeeding Syndrome ◽  
Improvement Project ◽  
Positive Effects ◽  
The Creation ◽  
The Impact

AimsThis project aimed to improve the knowledge and confidence of doctors at all levels when managing patients with eating disorders while on call.BackgroundA recent survey found just 1% of doctors have the opportunity for clinical experience on eating disorders. Anecdotally, a number of junior doctors within our trust had mentioned that they felt unsure when asked to manage patients with eating disorders during their out of hours shifts.MethodThis project aimed to ascertain levels of confidence with managing patients with eating disorders, and to collect suggestions to improve this. This was achieved using a survey sent out to 97 doctors working in a Mental Health Trust.We then utilised two of the suggestions to improve the identified areas of concern. The first method involved direct lectures. This was followed up with the creation of a poster highlighting the pertinent information which was displayed in key clinical areas. The second avenue was the creation of an information booklet covering key clinical information that is available to all on call doctors.ResultThe response rate for the survey was 37.11%. The survey found that doctors lacked confidence in the management of common conditions that arise in patients admitted with eating disorders. Refeeding syndrome was identified as the greatest area of concern by responding doctors.To assess the impact of the lectures, MCQs were given out before and after the presentation. The results were compared, and showed a clear improvement in overall knowledge, with results going from an average score of 56.6% to 80%.ConclusionBy using multiple methods to improve doctors confidence, (lectures, written information and visual posters), this quality improvement project achieved its aims in improving doctors knowledge, and through having easy access to important information, will have long term positive effects on patient care.

scholarly journals EP.TU.682Antibiotic Stewardship Within A General Surgery Department – A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Toks Fadipe
Keyword(s):  
Data Collection ◽  
Antimicrobial Stewardship ◽  
Low Frequency ◽  
Electronic Prescribing ◽  
Junior Doctors ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Improvement Project ◽  
Surgical Department ◽  
Chi Squared

Abstract Background Antimicrobial stewardship involves a coherent set of actions geared towards responsible use of antimicrobials. NICE antimicrobial stewardship guidance forms the basis for trust wide standards; the surgical department inconsistently complies to these standards. Aims Use of PDSA framework to improve departmental antibiotic prescribing practices. Methods Data collection via Meditech™ prescribing records and documentation. ‘Snapshots’ of antibiotic prescriptions for surgical inpatients taken collecting the following data: Cycle 1 data collection in August/September 2020, followed by a presentation distributed to junior doctors detailing importance of accurate prescribing. Cycle 2 data collection in October/November 2020 was followed by a summary of documentation/prescribing guidelines being circulated to surgical juniors. The final data collection period took place in November 2020. Analysis via Chi-Squared test. Results Interventions improved prescribing of correct antibiotics (75 to 89.3%), and documentation of IV antibiotic prescriptions with courses longer than 72 hours (p < 0.05). Similar insigificant improvements observed with reviewing prescriptions within 72 hours and samples sent to microbiology. Discussion Low frequency of samples sent to microbiology as antibiotics often used for surgical prophylaxis and continued post-operatively without prior cultures. Brief documentation on the ward round, accentuated by constraints enforced by Covid-19 pandemic. Conclusion Positive changes can be achieved from simple interventions. Sustainable changes in prescribing practices require engagement of entire clinical team and amendments to electronic prescribing.

scholarly journals 60 Post Inpatient Fall Medical Assessment (PIFMA) Performa Quality Improvement Project

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i18-i20
Author(s):  
M Chan ◽  
C W Tan ◽  
P Mathew
Keyword(s):  
Patient Safety ◽  
Financial Burden ◽  
The Elderly ◽  
Junior Doctors ◽  
Medical Assessment ◽  
Improvement Project ◽  
Pdsa Cycle ◽  
National Patient ◽  
Inpatient Falls ◽  
Medical Wards

Abstract Introduction Inpatient falls are the most commonly reported patient safety incidents and in the United Kingdom, there are 250,000 reported falls per year 1. A rapid response report (RRR) issued in 2011 by the NPSA highlighted need for improvement in identifying fractures and neurological observations. These figures reflect significant implications to patients’ health and financial burden to the NHS. Aims To improve assessment and documentation of inpatient falls assessment. Methods Two PDSA cycles were completed. First PDSA cycle established a baseline of post fall assessment and documentation in which raising awareness and teaching (RAT) to junior doctors was done. Second PDSA cycle identified room for further improvement and post inpatient fall medical assessment (PIFMA) Performa was developed to aid assessment and documentation for use of junior doctors. Feedback regarding the usefulness of the PIFMA Performa was collected via survey. Results The RAT intervention involved 30 patients of the Elderly wards in November and December 2017 and the PIFMA intervention involved 29 patients in all Medical wards in January and February 2019. The PIFMA Performa improved the time taken to review patients as per doctors survey. On comparing the RAT against PIFMA Performa interventions, documentation improved in the categories of physical examination (from 80% to 97%), neurological observations (from 49% to 98%), medication review (from 53% to 83%), and measuring lying standing blood pressure (from 83% to 90%). Conclusions Feedback from junior doctors states that the PIFMA Performa was certainly a very useful guidance tool and help to speed up documentation. These improvements only translated if junior doctors utilize the PIFMA Performa and so this is now being implemented in the trust policy. Further PDSA cycle can reassess if improvements truly represent the population cross-section. References 1. The incidence and costs of inpatient falls in hospitals (2017), NHS improvement. 2. National Patient Safety Agency NPSA/2011/RRR001 (13 January 2011).

WED 268 Improving junior doctors induction: queen square junior doctors handbook

2018 ◽  
Vol 89 (10) ◽  
pp. A39.2-A39
Author(s):  
Al-Mayhani Talal ◽  
Khalil Aytakin
Keyword(s):  
Quality Improvement ◽  
Medical Staff ◽  
Clinical Information ◽  
Junior Doctors ◽  
Information Contact ◽  
Improvement Project ◽  
Assessment Approach ◽  
Participatory Assessment ◽  
General Guidance

IntroductionAll junior doctors joining Queen Square undergo an induction package delivered along with the Queen Square Junior Doctors’ Handbook (QS-H). QS-H is supposed to provide general guidance to daily medical jobs in addition to useful clinical information, contact details and hints.AimThe aim of this quality improvement project (QIP) was to update, and improve, the quality of QS-H. The idea was that better and more informative induction can make carrying out daily jobs easier, increase the efficacy/effectiveness of medical staff and, ultimately, impact positively on patients care.MethodsIn this QIP a participatory assessment approach was employed where the opinions of the beneficiaries (junior doctors) were sought to screen for the strengths/weaknesses of the old version of QS-H, and to assess, later on, the new version.Results and conclusionMost junior doctors highlight the length of QS-H and the outdated information of its contents. Based on their suggestions a new, brief and practical version was drafted and was well received with some comments that led to additional round of improvement. Distributing hardcopies of QS-H around the wards further improved the junior doctors’ accessibility, efficiency, effectiveness and satisfaction.

299 Implementing A Formal Surgical Handover Tool for Junior Doctors – A QI Approach

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Gill ◽  
S Quested ◽  
J Lim ◽  
M Mohsin
Keyword(s):  
Improve Patient Safety ◽  
Clinical Information ◽  
Surgical Patient ◽  
Junior Doctors ◽  
Post Intervention ◽  
Perceived Safety ◽  
Surgical Department ◽  
Safe Patient Care ◽  
Improve Patient ◽  
Patient Handovers

Abstract Introduction An informative medical handover facilitates safe patient care. It was recognized that insufficient clinical information at handover resulted in unsafe communication in the general surgical department at Pinderfields General Hospital (PGH). We aim to utilise the Royal College of Surgeons’ (RCS) and British Medical Association’s (BMA) guidelines to improve the existing handover system, facilitate an efficient and relevant handover, and furthermore improve patient safety. Method General surgical foundation doctors (FDs) (n = 15) at PGH were surveyed to establish their perspectives of existing handover documentation. Subsequently a handover tool was iteratively designed, using tests of change, combining RCS and BMA guidelines with FDs’ suggestions of patient information required for safe handover. At two time points, FDs in the department were re-surveyed to measure improvement. Results Prior to implementation of a formal document, only 20% of FDs reported sufficient patient identifiers of the handover. This improved to 67% post intervention. Pre-intervention, 0% perceived the handover as ‘Excellent’, 20% as ‘good’. Post-intervention, these improved to 34% and 60% respectively. Conclusions Over six months, we improved the FD’s handover document, resulting in positive feedback of perceived safety of surgical patient handovers. However, recognised time constraints have highlighted the need for more efficient handover documentation.

scholarly journals 187 Improving Awareness of Managing Post-Operative Haemorrhage in Patients Undergoing Thyroid and Parathyroid Surgery: The SCOOP Protocol

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Bhattacharya ◽  
J Jegadeeson ◽  
J Ramsingh ◽  
P Truran
Keyword(s):  
Nursing Staff ◽  
Simulation Training ◽  
Clinical Signs ◽  
Skin Wound ◽  
Junior Doctors ◽  
Parathyroid Surgery ◽  
Surgical Department ◽  
Life Threatening ◽  
Clinical Questions ◽  
Life Threatening Complication

Abstract Introduction Post-operative haemorrhage is a rare but potentially life-threatening complication of thyroid surgery and occurs in 1 in 100 patients. Our aim was to assess current levels of awareness of post-operative haemorrhage in the surgical department and to improve confidence in managing this. Method Questionnaires with a combination of clinical questions were distributed amongst nurses, foundation doctors, senior house officers and registrars in the surgical department. Results There was a clear gap in awareness in all grades. The British Association of Endocrine and Thyroid surgeons (BAETS) have guidance on the management of these patients and in particular the acronym SCOOP (Steristrips removed, Cut subcuticular sutures, Open skin wound, Open strap muscles, Pack wound). 18/24 of participants had not heard of the SCOOP protocol. Most nurses (6/12) all junior doctors (8/8) showed lack of confidence in managing patients with suspected bleeding. Conclusions An informative poster was created for relevant clinical areas as per the BAETS recommendation. These posters outlined the steps in the SCOOP acronymas well as the main clinical signs of haemorrhage. BAETS recommend that all first responders, including nursing staff, junior doctors and the crash team should be aware of the SCOOP protocol. Simulation training sessions are in progress for these members of staff.

scholarly journals 291 Pre-Operative Venepuncture: An Audit of The Trauma and Orthopaedic Department at The Royal Sussex County Hospital, Brighton

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Harris ◽  
T Antonio ◽  
A Hagiga ◽  
D Crone
Keyword(s):  
Major Trauma ◽  
Elective Surgery ◽  
Financial Burden ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Inclusion Criteria ◽  
Blood Testing ◽  
Orthopaedic Department ◽  
Minor Surgery ◽  
Routine Coagulation

Abstract Background NICE recommends that patients undergoing intermediate or minor elective surgery do not need routine coagulation or transfusion blood testing unless they are ASA 3+ or taking anticoagulation mediation, where testing may be considered. Currently there is no guidance for trauma patients. Method We identified all patients that underwent intermediate or minor trauma and orthopaedic surgery within a three-month period from December 2019- February 2020 at the RSCH. We excluded major trauma patients, patients taking anticoagulants and patients with complex admission or past medical history. Computer records were used to identify pre-operative investigations and admission history. Results 843 patients met our inclusion criteria. In total, 92 clotting studies and 200 transfusion samples were taken preoperatively. The majority of tests were for patients undergoing ankle 130/292 (45%) or Tibia/Fibula 54/292 (18%) procedures. This equates to approximately 1168 blood tests per year. Based on the lab cost of £15.97 for a transfusion sample and £18 for a coagulation sample, this is a cost of approximately £19,616 each year on blood testing that is not indicated. Discussion We hope that by presenting these results we will help reduce the unnecessary time and financial burden of routine venipuncture in departments undertaking intermediate and minor surgery.

scholarly journals Reaching the summit of discharge summaries: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001142
Author(s):  
Richard Thomas Richmond ◽  
Isobel Joy McFadzean ◽  
Pramodh Vallabhaneni
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Improve Patient Care ◽  
Discharge Summary ◽  
Shop Floor ◽  
Junior Doctors ◽  
Improvement Project ◽  
Step Model ◽  
Assessment Unit ◽  
Discharge Summaries

BackgroundDischarge summaries need to be completed in a timely manner, to improve communication between primary and secondary care, and evidence suggests that delays in discharge summary completion can lead to patient harm.Following a hospital health and safety review due to the sheer backlog of notes in the doctor’s room and wards, urgent action had to be undertaken to improve the discharge summary completion process at our hospital’s paediatric assessment unit. It was felt that the process would best be carried out within a quality improvement (QI) project.MethodsKotter’s ‘eight-step model for change’ was implemented in this QI project with the aim to clear the existing backlog of pending discharge summaries and improve the timeliness of discharge summary completion from the hospital’s paediatric assessment unit. A minimum target of 10% improvement in the completion rate of discharge summaries was set as the primary goal of the project.ResultsFollowing the implementation of the QI processes, we were able to clear the backlog of discharge summaries within 9 months. We improved completion within 24 hours, from <10% to 84%, within 2 months. The success of our project lies in the sustainability of the change process; to date we have consistently achieved the target completion rates since the inception of the project. As a result of the project, we were able to modify the junior doctor rota to remove discharge summary duty slots and bolster workforce on the shop floor. This is still evident in November 2020, with consistently improved discharge summary rates.ConclusionQI projects when conducted successfully can be used to improve patient care, as well as reduce administrative burden on junior doctors. Our QI project is an example of how Kotter’s eight-step model for change can be applied to clinical practice.

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