Handover among junior doctors: a quality improvement study

2019 ◽  
Vol 25 (6) ◽  
pp. 1-7
Author(s):  
Aamer Sarfraz ◽  
Yvonne Igunma ◽  
Ben Harman-Jones
Keyword(s):  
Length Of Hospital Stay ◽  
Clinical Information ◽  
Junior Doctors ◽  
Face To Face ◽  
Handover Procedure ◽  
Before And After ◽  
Communications Skills ◽  
Positive Experiences ◽  
Area Of Concern ◽  
Efficient Transfer

Background/Aims Handover is a procedure that ensures efficient transfer of clinical information across teams. It is also an opportunity for junior doctors to develop clinical competencies, communications skills and leadership. Poor handovers can result in delays, clinical errors, duplication of work, poor morale, increased length of hospital stay, and risk of harm to patients. Poor handovers were identified as an area of concern for two successive years in the General Medical Council's survey. Methods Measures were undertaken to address this by updating their handover policy, developing a new handover protocol and instigating rota monitoring by involving junior doctors and consultants through focus groups. A survey was conducted among the same cohort of junior doctors before and after the interventions. Findings There was a remarkable improvement in junior doctors' attitudes towards safety, frequency of face-to-face handover, use of a handover book, and overall positive experiences of the handover procedure. Conclusions It is worth examining the approach to handover among other health professionals and perhaps between professions regarding the same patients.

scholarly journals Deaf Awareness Workshop for Medical Students—An Evaluation

2021 ◽  
Author(s):  
Janina Kruse ◽  
Anja Zimmermann ◽  
Michael Fuchs ◽  
Daisy Rotzoll
Keyword(s):  
Medical Students ◽  
Online Survey ◽  
Awareness Training ◽  
Face To Face ◽  
Self Evaluation ◽  
Current Period ◽  
Before And After ◽  
Medical Faculties ◽  
Positive Experiences ◽  
Catch Up

Abstract Background In the present study, a workshop was designed to determine the effect of deaf awareness training on medical students concerning their gain of knowledge regarding deafness and their competence in providing adapted communication and healthcare for deaf and hard of hearing patients. Methods Knowledge and competence in 95 medical students were evaluated in an online survey prior to as well as following the workshop. The workshop was held online in three consecutive sessions. Results Students reported a substantially more confident approach to working with hearing impaired patients and indicated that an online learning environment is a suitable and helpful alternative to face-to-face teaching. However, a direct comparison was not conducted. Participants improved significantly in all evaluated items concerning their knowledge and competence (p <0.001). Furthermore, measurements revealed interaction effects between students’ current period of study and the point in time of self-evaluation before and after the workshop. Preclinical students not only catch up but even surpass their clinical peers concerning their learning outcome. Conclusion Reviewing the results obtained by this study, we are optimistic with respect to all participants’ highly positive experiences and learning outcomes. Deaf awareness training should be included in the curriculum of all medical faculties.

scholarly journals eHub: Enhancing the emergence of the electronic consultation

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703673
Author(s):  
Ross Dyer-Smith ◽  
Gurbaksh Badial
Keyword(s):  
Clinical Training ◽  
Core Competency ◽  
Training Programme ◽  
Face To Face ◽  
Electronic Consultation ◽  
Educational Package ◽  
Before And After ◽  
Consultation Training ◽  
Area Of Concern

BackgroundAlternatives to face-to-face consulting (F2F) with patients have been developed including telephone consulting and e-consulting. One area of concern about both alternatives is that they may act to increase total consultation time by generating additional F2F consultation activity.AimTo determine the proportion of clinical e-consults where a GP requested a follow-up F2F consultation and to determine whether e-consultation training reduced the proportion of GP requests for a follow-up F2F consultation.MethodA longitudinal study was conducted observing ‘remote closure’ rates (the proportion of clinical e-consults with no F2F follow-up appointment) before and after the launch of a dedicated at scale electronic consultation ‘eHub’ with a bespoke technical and clinical training programme. Remote closure rates were available for 42 months prior and 22 months following the intervention. A follow-up GP consultation was defined as the doctor requesting the patient to make a F2F appointment.ResultsThe remote closure rates were 63% (3019/4778) before and 87% (6957/7993) after the intervention. χ2 with Yates correction 1024.9; P<0.001.ConclusionThe consultation as a core competency of GP training requires specific skills for e-consulting. We have devised a training package for e-consultation training. Following implementation of a package of intensive e-consultation training, remote closure rates of 87% were obtained. Some of the observed increase in remote closure rates may have been attributable to increased familiarity of both GPs and patients with new models of consultation. We plan to test our e-consulting educational package in other settings with low e-consultation closure rates.

scholarly journals PARE0007 PATIENT AND PUBLIC INVOLVEMENT IN CLINICAL TRIAL DESIGN

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1289.1-1290
Author(s):  
S. De Souza ◽  
R. Williams ◽  
E. Johansson ◽  
C. Zabalan ◽  
T. Esterine ◽  
...  
Keyword(s):  
At Risk ◽  
Lived Experience ◽  
Public Involvement ◽  
Clinical Trial Design ◽  
Patient And Public Involvement ◽  
Face To Face ◽  
Before And After ◽  
Extensive Consultation ◽  
New Perspective ◽  
The Eu

Background:Patient and public involvement (PPI) is gaining increasing recognition as important in ensuring research is relevant and acceptable to participants. Rheuma Tolerance for Cure (RTCure) is a 5 year international collaboration between academia and industry; focusing on earlier detection and prevention of rheumatoid arthritis (RA) through the use of immune-tolerising treatments.Objectives:To bring lived experience and insight into scientific discussions; and to evolve collaboration between lay representatives and academia/industry.Methods:9 Patient Research Partners (PRPs) from 5 European countries were recruited via the EULAR PARE Network and institutions within the RTCure Consortium (8 PRPs with RA and 1 ‘at risk’). They were asked to enter into a legal agreement with the Consortium. PRPs participated in teleconferences (TCs) and were invited to attend face-to-face (F2F) meetings at least annually. Requests for input/feedback were sent from researchers to PRPs via the project’s Patient Engagement Expert [SK].Results:PRP involvement has given researchers and industry partners a new perspective on patient priorities, and focused thought on the ethics of recruitment for and participation in clinical trials of people ‘at risk’ of developing RA. PRPs have helped define the target populations, given their thoughts on what types of treatments are acceptable to people ‘at risk’ and have aided the development of a survey (sent to EULAR PARE members) regarding the use of animal models in biomedical research. Positive informal feedback has been received from researchers and industry regarding the contribution of PRPs to the ongoing project (formal evaluation of PPI in RTCure will be carried out in 2020 and at the project end in 2022).Challenges:Legal agreements- Many PRPs refused to sign the Consortium’s complex PRP Agreement; feeling it unnecessary, incomprehensible and inequitable. After extensive consultation with various parties (including EULAR and the Innovative Medicines Initiative) no similar contract was found. Views for its requirement even varied between legal experts. After 2 years of intense discussion, a simple non-disclosure agreement was agreed upon. Ideally any contract, if required, should be approved prior to project onset.Meeting logistics- Other improvements identified were to locate the meeting venue and accommodation on the same site to minimise travel, and to make it easier for PRPs to take breaks when required. This also facilitates informal discussions and patient inclusivity. We now have agreed a policy to fund PRPs extra nights before and after meetings, and to bring a carer if needed.Enabling understanding– Future annual meetings will start with a F2F meeting between PRPs and Work Package Leads. Researchers will be encouraged to start presentations with a summary slide in lay language. Additionally, an RTCure Glossary is in development.Enabling participation– SK will provide monthly project updates and PRP TCs will be held in the evening (as some PRPs remain employed). PRPs will be invited to all project TCs and F2F meetings. Recruitment is underway to increase the number of ‘at risk’ PRPs as their viewpoint is vital to this study.Conclusion:Currently PPI in RTCure is an ongoing mutual learning process. Universal guidance regarding what types of contracts are needed for PPI would be useful. Communication, trust and fruitful discussions have evolved through F2F meetings (both formal and informal) between PRPs, academia and industry. It is important that all parties can be open with each other in order to make PPI more meaningful.Acknowledgments:This work has received support from the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking RTCure grant number 777357.Disclosure of Interests:Savia de Souza: None declared, Ruth Williams: None declared, Eva Johansson: None declared, Codruta Zabalan: None declared, Tom Esterine: None declared, Margôt Bakkers: None declared, Wolfgang Roth: None declared, Neil Mc Carthy: None declared, Meryll Blake: None declared, Susanne Karlfeldt: None declared, Martina Johannesson: None declared, Karim Raza Grant/research support from: KR has received research funding from AbbVie and Pfizer, Consultant of: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai, Speakers bureau: KR has received honoraria and/or consultancy fees from AbbVie, Sanofi, Lilly, Bristol-Myers Squibb, UCB, Pfizer, Janssen and Roche Chugai

Improvement in Total and Face-to-Face Provider Time in a Multidisciplinary Craniofacial Team Clinic: An Interventional Study

2021 ◽  
pp. 105566562110217
Author(s):  
Alexis C. Wood ◽  
C. Alejandra Garcia de Mitchell ◽  
Ruchi Kaushik
Keyword(s):  
Data Collection ◽  
Cleft Palate ◽  
Outcome Measures ◽  
Clinic Visit ◽  
Visit Time ◽  
Time Data ◽  
Interventional Study ◽  
Face To Face ◽  
Before And After ◽  
Total Visit

Objective: Identify factors contributing to time a family spends in a Multidisciplinary Craniofacial Team Clinic (MDCT) and implement an intervention to reduce this time. Design: Interventional: a restructuring of clinics to serve those patients requiring fewer provider encounters separately. Setting: An American Cleft Palate-Craniofacial Association-accredited MDCT in an academic children’s hospital. Patients/Participants: One hundred sixty-seven patients with craniofacial diagnoses. Interventions: Time data were tabulated over ∼2 years. Following 9 months of data collection, patients requiring fewer provider encounters were scheduled to a separate clinic serving children with craniosynostosis, and data were collected in the same fashion for another 14 months. Main Outcome Measures: Principal outcome measures included total visit time and proportion of the visit spent without a provider in the room before and after clinic restructuring. Results: The average time spent by family in a clinic session was 161.53 minutes, of which 64.3% was spent without a provider in the room. Prior to clinic restructuring, a greater number of provider encounters was inversely associated with percentage of time spent without a provider ( P < .001). Upon identifying this predictor, scheduling patients who needed fewer provider encounters to a Craniosynostosis Clinic session resulted in reduction in absolute and percentage of time spent without a provider ( P < .001). Conclusions: The number of provider encounters is a significant predictor of the proportion of a clinic visit spent without a provider. Clinic restructuring to remove patient visits that comprise fewer provider encounters resulted in a greater percentage of time spent with a provider in an MDCT.

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 How does participation in a voluntary prize exam affect medical students’ knowledge and interest in ENT, plastic surgery, ophthalmology and dermatology?

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Razan Nour ◽  
Kerry Jobling ◽  
Alasdair Mayer ◽  
Salma Babikir
Keyword(s):  
Medical Students ◽  
Plastic Surgery ◽  
Pilot Project ◽  
Junior Doctors ◽  
Free Text ◽  
Medical Specialties ◽  
Spare Time ◽  
Before And After ◽  
To Receive ◽  
Interest And Knowledge

Abstract Background Otolaryngology (ENT), plastic surgery, ophthalmology and dermatology are medical specialties which tend to receive less coverage in UK medical school curricula compared to larger, generalist specialties. As a result, there are fewer opportunities for medical students to learn and to cultivate an interest. There are numerous papers that report concerns about junior doctors’ ability to manage conditions within these specialties, which may jeopardise patient safety. The aim of our pilot project was to increase medical students’ interest and knowledge of ENT, plastic surgery, ophthalmology and dermatology. In addition to describing our project, we present and discuss literature on UK undergraduate education in these specialties and its impact on preparedness of junior doctors and future career choices. Methods One hundred twelve final year medical students at Newcastle University were invited to take part in a voluntary two-part (written and clinical) exam, in which prizes could be won and all participants would receive a certificate of participation. We distributed two online surveys to the students, one administered before the exam and one afterwards. Data was collected regarding the students’ motivation for entering the prize exam and the students’ baseline interest and knowledge in these specialties before and after the prize exam. Free-text responses were collected about the students’ opinion of the project and whether participation was beneficial. Results Sixteen students participated in the exam. There was a statistically significant increase in the students’ knowledge in ENT (p < 0.000), plastic surgery (p < 0.000), ophthalmology (p < 0.028) and dermatology (p < 0.012) after participation in the exam, but not in their interest levels. ENT was the preferred specialty of our cohort. The students reported that they found participation beneficial to their learning, particularly receiving exam feedback and explanations to exam questions. Conclusions This pilot project was a useful intervention in increasing medical students’ knowledge in these specialties, but not in their levels of interest. It also demonstrates that medical students are willing to participate in voluntary initiatives (in their spare time) to gain more learning opportunities and that medical students value timely exam feedback to guide their revision.

scholarly journals The Figure of the Teacher-Prosumer for the Development of an Innovative, Sustainable, and Committed Education in Times of COVID-19

2021 ◽  
Vol 13 (3) ◽  
pp. 1128
Author(s):  
Laura Triviño-Cabrera ◽  
Elisa Isabel Chaves-Guerrero ◽  
Laura Alejo-Lozano
Keyword(s):  
Social Sciences ◽  
Sustainable Development ◽  
Primary Education ◽  
Online Teaching ◽  
Qualitative Methodology ◽  
Educational Innovation ◽  
Active Role ◽  
Public Access ◽  
Face To Face ◽  
Before And After

Studies on the adaptation from face-to-face to online teaching during lockdown show the before and after in education that faces the double challenge of promoting digital skills and public access to connectivity and electronic devices in the post-COVID-19 era. Therefore, this article contributes to these new emerging lines of educational research by presenting an educational innovation project called “Teachers Versus COVID-19”. This project aimed to verify whether the figure of teacher-prosumer, that is, consumers of media culture and creators of their own educational resources, favors the initial training of teachers during the pandemic. To this end, the following objectives were proposed: firstly, test whether the figure of the teacher-prosumer contributes to improving the adaptation of face-to-face teaching to the virtual modality of the Didactics of Social Sciences in the Degree in Primary Education during lockdown; secondly, analyze the production of content on social networks by the students in the Degree in Primary Education, according to the objectives of sustainable development. To validate our teacher-prosumer proposal, we chose the design-based research (DBR) qualitative methodology. For this, 240 students from the course in Didactics of Social Sciences of the Degree in Primary Education at the University of Malaga created 37 educational videos that teach the social sciences curriculum to children between 6 and 12 years of age from the perspective of relevant social problems and the Sustainable Development Goals. These videos were disseminated through the project’s YouTube channel. The results of this study corroborate the effectiveness of turning students into teachers-prosumers, generating the development of critical, creative, digital, and socio-emotional skills so that they feel committed to playing an active role in social changes for a sustainable world.

scholarly journals Pictorial health warning labels on the waterpipe device are effective in reducing smoking satisfaction, puffing behaviour and exposure to CO: first evidence from a crossover clinical laboratory study

2019 ◽  
Vol 28 (e1) ◽  
pp. e37-e42 ◽  
Author(s):  
Wasim Maziak ◽  
Ziyad Ben Taleb ◽  
Mohammad Ebrahimi Kalan ◽  
Thomas Eissenberg ◽  
James Thrasher ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Clinical Laboratory ◽  
Warning Labels ◽  
Health Warning ◽  
Before And After ◽  
Regulatory Approach ◽  
The Usa ◽  
Exhaled Carbon Monoxide ◽  
Positive Experiences ◽  
Harmful Effects

ObjectivesThis study examined the effect of pictorial health warning labels (HWLs) on the waterpipe (WP) device on smokers’ experience, puffing behaviour, harm perception and exposure to respiratory toxicants.MethodsThirty WP smokers completed two 45 min ad libitum smoking sessions (WP without HWL vs WP with HWL) in a crossover design study. Exhaled carbon monoxide (eCO) was measured before and after each smoking session. Puff topography was recorded throughout the smoking session, and participants completed survey questionnaires assessing subjective smoking experiences and harm perception.ResultsSignificant differences were observed in eCO levels between the two study conditions, with lower levels of eCO boost recorded following smoking the WP fitted with HWL (16 ppm) compared with WP without HWL (22.7 ppm). Participants had more puffs, shorter interpuff intervals and a higher total puff volume during smoking the WP without HWL relative to WP with HWL (p values <0.05). We documented enhanced reports of satisfaction, taste and puff liking following smoking the WP without HWL compared with the WP with HWL. WP harm perception was significantly higher among participants after smoking the WP with HWL compared with WP without HWL.ConclusionThis pilot study shows that placing HWL on the WP device is effective in reducing WP smoker’s positive experiences, puffing parameters and exposure to carbon monoxide. HWLs lead also to more appreciation of WP harmful effects, making them a promising regulatory approach for addressing the spread of WP smoking among young adults in the USA.

scholarly journals Impact of a blended curriculum on nursing handover quality: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001024
Author(s):  
Xavier Losfeld ◽  
Laure Istas ◽  
Quentin Schoonvaere ◽  
Michel Vergnion ◽  
Jochen Bergs
Keyword(s):  
Educational Intervention ◽  
Patient Information ◽  
Professional Communication ◽  
Fit Indices ◽  
Negative Consequences ◽  
Improvement Project ◽  
Face To Face ◽  
Before And After ◽  
Post Test ◽  
E Learning

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality.MethodsWe used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES.ResultsThe original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01).ConclusionThe applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.

A multifaceted stewardship intervention helps curb steroid overprescribing in hospitalized patients with acute exacerbations of COPD

2021 ◽  
Author(s):  
Jennifer L Cole ◽  
Sarah E Smith
Keyword(s):  
Length Of Stay ◽  
Intervention Strategy ◽  
Audit And Feedback ◽  
Face To Face ◽  
Duration Of Therapy ◽  
Significant Difference ◽  
Acute Exacerbations ◽  
Before And After ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention strategy on inpatient steroid prescribing in patients with acute exacerbations of COPD (AECOPD). Summary Investigators implemented a 3-part stewardship initiative consisting of (1) an anonymous survey for providers on steroid prescribing in a simplified case of AECOPD, (2) face-to-face education and review of survey results, and (3) prospective audit and feedback from a clinical pharmacist. This was a quasi-experimental before-and-after study evaluating hospitalized adults diagnosed with AECOPD in two 12-month study periods before (April 2019-March 2020) and after (May 2020-April 2021) implementation. The primary outcome was mean inpatient steroid dosing. Secondary outcomes were duration of therapy, length of stay (LOS), 30-day readmissions, 30-day mortality, and incidence of hyperglycemia. Per power analysis, there were 27 patients per cohort. The interventions resulted in a significant reduction in prednisone equivalents during hospitalization: 118 mg vs 53 mg (P = 0.0003). This decrease was similar in ICU (160 mg vs 61 mg, P = 0.008) and non-ICU (102 mg vs 49 mg, P = 0.004) locations. There was no significant difference in duration of therapy (8 days vs 7 days, P = 0.44), length of stay (3.3 days vs 3.9 days, P = 0.21), 30-day mortality (4% vs 7%, P = 0.55), 30-day readmissions (15% vs 7%, P = 0.39), or rate of hyperglycemia (48% vs 44%, P = 0.78). Conclusion A multifaceted stewardship intervention significantly reduced steroid dosing in hospitalized AECOPD patients. This reduction was not associated with known deleterious effects.

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