1231 A Full-Cycle Audit Of ‘Safe’ Surgical Handovers in A Tertiary Centre

Aim 1. Assess performance in surgical handovers at Southampton General Hospital (SGH) against RCS ‘Safe Handover’ guidelines Identify any areas for improvement to ensure safe and effective handover of surgical patients Method 10 evening surgical handovers were anonymously audited In October 2019 against RCS ‘safe handover’ guidelines. The results were subsequently analysed and circulated amongst the surgical department. Handovers were then led consistently by surgical registrars and advanced nurse practitioners (ANPs). A prompt including the RCS handover guidelines was made and distributed to all members of the surgical team and included in departmental inductions. Following this, a further 10 evening handovers were anonymously audited between July and August 2020. Results Many aspects of handover performance descriptors described by the RCS in the re-audit improved following the circulation of our prompt including RCS handover guidelines and examples of minimum or good standards of practice for handover. Specifically, handover timeliness, the briefings provided (100% from 70%), the audibility of a single speaker (70% from 30%), the number of educational discussions held during handovers (100% from 50%) and awareness of the on-call overnight consultant (100% from 80%) all vastly improved. Conclusions Emphasis on undertaking effective handovers needs to continue as ‘safe' handovers between shifts can protect both patient and doctor safety. This is especially true following the implementation of the European Working Time Directive (EWTD) and a move to full shift working. Handovers are also proposed as opportunities for training which may be helpful especially in an era of reduced hours of surgical training.

7. Working time

Each Concentrate revision guide is packed with essential information, key cases, revision tips, exam Q&As, and more. Concentrates show you what to expect in a law exam, what examiners are looking for, and how to achieve extra marks. This chapter focuses on the Working Time Regulations 1998 (WTR). The WTR implement the Working Time Directive 1993 and parts of the Young Workers Directive 1994. The WTR impose a maximum 48-hour week during a 17-week reference period and provide rules on night work, rest periods, and annual leave. The UK has opted out of the maximum 48-hour working week. It was the sole European Union Member State to do so. On Brexit, the WTR are one of the areas which may come under attack from neoliberals.

On-call handover ‘– if it isn't documented then it didn't happen’

Aims1. To standardise the doctor handovers for on-call duties2. To ensure there is documented evidence of handover taking place at the end of each shiftBackgroundSince the introduction of the European working time directive the amount of hours that doctors are allowed to work has been reduced, resulting in increased handovers between teams. The National Patient Safety Committee and General Medical Council have recognised that this means we need to ensure handovers are as safe and robust as possible to ensure that patient safety is not compromised. A recent serious investigation report carried out at Chase Farm Hospital, London identified a lack of formalised handover between doctors as a contributing factor leading to patient harm. One of the recommendations of the report was for a Quality Improvement Project to be carried out in order to formalise handover.The handover procedure at Chase Farm Hospital for core trainee doctors 'on-call' prior to this QIP was not standardised and consisted of an informal, verbal handover. Frustrations had been raised by doctors and other staff members that this current method of handover was unreliable and unsafe.MethodWe sent out a questionnaire about handover to all doctors on the on-call rota to help establish what intervention would be appropriate.We then performed a retrospective collection of documented handovers within a two month time period.Our intervention was to introduce an email handover procedure.Following a two month trial of this intervention, we resent the questionnaire and performed a second retrospective collection of handover documentation.ResultPrior to this QIP we found that 0% of on call handovers were being formally documented. After the introduction of our handover email 88% of handovers were being formally documented using the handover email.Satisfaction with the handover procedure went from 0% being very satisfied and only 33% being satisfied to 50% being satisfied and 50% being very satisfied.ConclusionA standardised and documented handover procedure is crucial for patient safety and to allow doctors to communicate jobs effectively with each other.A secure email for handover is a successful way of formalising the handover process.Limitations include:Access to the handover email for new staff or locum staff.Ensuring that doctors who aren't on the on-call rota know how to use it to handover their ward jobs.

Factors relating to working hours restriction that have impacted the professional identity of trainees in the last decade

Ever-developing changes to the working hours of junior doctors by the European Working Time Directive, the junior doctor contract of 2019 and most recently the COVID-19 pandemic have impacted the professional identity of doctors. There has been little investigation into its influence on the multifaceted aspects of postgraduate medical training, which feeds into how trainees consider themselves professionally and the concept of professional identity or ‘being a doctor’. A review of the medical, socio-political and educational literature reveals that the impact on the professional identity development of trainees is influenced by several perspectives from the trainee, trainer and the public. Gross reduction in working hours has no doubt decreased the raw volume of clinical experiences. However, to counteract this, smarter learning processes have evolved, including narrative reflection, supervised learning events, and a greater awareness of coaching and training among trainers.

Introducing the autonomous employee category: The chance to create a flexible and secure employment relationship?

In 2018, the Estonian Ministry of Social Affairs came up with idea of introducing a new category of employee – the autonomous employee – in Estonia. This concept is based on Article 17(1) of the Working Time Directive, which allows derogations from the scope of the Directive for managing executives or other persons with autonomous decision-taking powers. The implementation of the concept of the autonomous employee has been seen as a panacea that makes the organisation of working time more flexible and the regulation relevant to practical needs. However, according to the case law of the European Court of Justice, the scope of Article 17(1) is very narrow. The article examines the concept of the autonomous employee, the nature and organisation of autonomous work, mainly based on EU law, as well as the Finnish Working Hours Act and amendments to the Estonian Sports Act, both of which entered into force in 2020.

Unionsrechtliche Gestaltungsspielräume für die Arbeitszeit von Wissensarbeitern

"Is the Working Hours Act still up to date?" This question is one of the hot topics of the digital world of work. There is agreement that new technologies make it possible to work independently of time and place. However, opinions differ on the effects of ever new technical possibilities on the protection of working time. This work is dedicated to the legal phenomenon of knowledge work and shows as yet unused possibilities for making working time law more flexible. Based on an examination of the deviation regulations of the Working Time Directive, the author formulates proposals for reforming the ArbZG.

THE NATIONAL COURT FOLLOW-UP IN THE CJ EU CASE “SINDICATUL FAMILIA E.A.” REGARDING THE WORKING TIME OF FOSTER PARENTS IN ROMANIA

The CJEU judgement in Sindicatul Familia case (C‑147/17) is a steppingstone for the working time Directive 2003/88 interpretation and application and for the European debate regarding the foster carer for children statute, the remuneration and working time. The article presents the national court decision following the CJEU judgement accompanied by the author´s commentaries. The purpose of the article is to provide legal professionals with the information on the practical results of the dialog between CJEU and national courts and the way national courts use European legislation interpretations given in the preliminary ruling procedure aiming at its uniform application in the EU member states.

national court follow-up in the CJEU case "Sindicatul Familia e.a.” regarding the working time of foster parents in Romania

The CJEU judgement in Sindicatul Familia case (C‑147/17) is a steppingstone for the working time Directive 2003/88 interpretation and application and for the European debate regarding the foster carer for children statute, remuneration and working time. The article presents the national court decision fallowing the CJEU judgement accompanied by the author commentaries. The purpose of the article is to offer to legal professionals the information on the practical result of the dialog between CJEU and national courts and the way national courts uses the European legislation interpretations given in the preliminary ruling procedure that aims an uniform application of it in the EU member states.

A little less autonomy? The future of working time flexibility and its limits

The European Court of Justice has recently issued rulings on the interpretation of the European Working Time Directive 2003/88, which appear to restrict flexible working time arrangements (especially Matzak C-518/15, Syndicat C-254/18 and CCOO C-55/18). Only a few months prior to the latter ruling of the CJEU, the Austrian legislator amended the Working Time Act in order to make it more flexible. The article argues that the measures taken by the Austrian legislator to enable more flexibility and autonomy can still be regarded as compatible with Union law. In general, the article tackles the question of possible further legislative developments in order to strike a balance between autonomy and the need for security of both parties to the employment relationship. Among other suggestions, the article introduces the concept of molecularisation of working time and examines whether work intensity should be introduced as a qualitative dimension to the concept of working time, thus deviating from the current European Working Time Directive. Finally, the article suggests security measures – often referring to Austria as a best practice example – in order to safeguard workers in view of working time flexibility.

‘Slepen al the nyght with open ye’: Personal reflections after 35 years of being on-call

The European Working Time Directive (2003) has had a significant impact in reducing the total number of hours worked per week, as well as shift-lengths. There is, however, no agreement on optimal shift-lengths and day/night work balance in different medical specialities. Given the time it takes for clinical events to unfold, particularly in relation to labour, there may be advantages in retaining the 24 hours on-call shift for obstetricians––in the interests of patient care and training. Increasingly seen as a relic of the past, this shift-length merits further research, which should include the impact on clinician well-being.