Forging Foundations TogetherWill Barker

James Houston

www.dr-toolbox.com

4th April 2014

“It’s 0930 on Day 2 into working here and the Consultant already seems cross with me…

The SpR is in theatre and I need to book an outpatient clinic, a Contrast CT, refer to the

respiratory team and get a pain team review…

I can’t remember any of this from induction!”

2004 2012

2009 study identified 6% increase in mortality in August [1]

•Shadowing periods – information overload– many unknown questions still at end– new questions arise post changeover

•Paper guides– frequently lost– quickly out of date– cumbersome to carry around

• Starting in a Hospital as a Junior Doctor is a bewildering and stressful period in your career!

• Common tasks are often more difficult than they should be and include:– Requesting many different tests – Making referrals to many different specialities– Using hospital guidelines that are difficult to find

• More time (and stress) is often spent finding out how to do such tasks rather than actually doing the tasks themselves.

• IT intranets within hospitals often contain such information which is:– Difficult to find – Difficult to update and seldom updated– Not specific to Junior Doctors

• Patient safety is compromised, time is wasted and stress is incurred if these tasks are done incorrectly

• Spending less time on these tasks, would mean more time available on items relevant to the post-graduate curriculum and our learning

• Provide specific, local information on how to get things done in hospitals

• Improve the efficiency (and learning environment) of junior doctors. Increasing time for training

• Improve patient safety by

facilitating a better handover

between rotating doctors

“If only there was an accessible guide to the hospital

With local information on how to do daily jobs

written by junior doctors for junior doctors…”

http://dr-toolbox.com/Demo

• Handover guides for all F1/F2 firms

• Bleeps of doctors & MDT

• Extension numbers for wards, secretaries

• Reference guides specific to the hospital

• How to make speciality referrals – within the hospital

• How to request specific investigations – within the hospital

• A resource for teaching – And post graduate medical education

• Password protected • Easily updatable• Specific to Junior Doctors working at their individual

hospitals• Available on

– hospital intranet, – a home computer or – a mobile phone

• Simple to set up for other NHS trusts

• 2/3 disagreed that induction covered all they needed to know.

• Around 80% wanted more information on how to contact medical teams, the MDT and making referrals

• More than half did not know what was expected of them

• 81.0% of F1s have used Toolbox

Of those Drs that used the Toolbox• 94% found it a useful way to access information• 100% felt it saved them time• Self reported time saved (per day):

– Mean = 39.4 minutes– SD = 17.8 mins

• Analytics: Approx 2000 hits per month

• F1’s are less likely to contact senior when finding out how to request a test after 1 month (p = 0.015)

• F1’s are less likely to contact a senior when finding out how to make referrals after 1 month (p = 0.001)

• Renamed Dr Toolbox– But are very grateful to DAPS

• Endorsement by NHS Medical Director– Sir Bruce Keogh

• Health Education England– Inspire Improvement BTBC– £15,000 to develop an app

• 35 Dr Toolbox sites– 25 new sites over the last year– NW Thames Deanery leadership programme– SW England, NW England, Northern Ireland

• https://www.youtube.com/watch?v=fW8amMCVAJQ

• Set up a Toolbox for your Trust

• Complete your own QI Project

• Develop your leadership skills

YOUR TRUST NEEDS

Finalise site & add to intranet

Set up roles within Team

Baseline survey

Send out forms for handover guides

Begin to input data

Upload common forms

Repeat SurveyEnsure continuity

Launch

Gather relevant bleeps and extensions nos

December Changeover

• Managing a larger sized project• Being inundated with requests for new sites• Trouble-shooting takes up more time• Over a hundred doctors involved in one way or another,

so we need to find new ways of co-ordination• Members of the team have moved• Balancing projects with training • Children!

• Watch this 5 minute video on implementing technology• https://www.youtube.com/watch?v=C1CP0HJtlRk

• Projects aren’t just some tickbox in the CV for juniors• Senior (permanent) staff input is critical• Local ownership• Build into plan sustainability & handover• Make projects simple at the start….

• Stick with it, good times and bad times

• Rotations can be advantageous to spread good ideas

• Think about the resources needed to sustain your initiative

• Don’t be afraid to get your hands dirty making websites– but it helps to know at least one expert

• Web apps & tablet computers are now very reliable and affordable– huge opportunities to improve care and work environment

• Support your champions

• Challenge people who say it cant be done – but don’t waste time trying to change their minds

References:1.Jen MH et al. Early in-hospital mortality following trainee doctors' first day at work. PLoS One. 2009 Sep 23;4(9):e71032.Doctors Advancing Patient Safety (DAPS)

www.dr-toolbox.com