Early signals of Omicron severity in sentinel UK hospitals (preprint)

On 26th November 2021, a novel SARS-CoV-2 variant B.1.1.529 (Omicron variant) was designated as a variant of concern by the World Health Organisation. Using data from the Virology laboratory at the Manchester Medical Microbiology Partnership (MMMP, a partnership between UKHSA and the Manchester Foundation Trust), we have extracted a real-time feed of Omicron samples from hospitals across Greater Manchester, an area of the United Kingdom with a population size of approximately three million individuals. Omicron hospital samples are growing exponentially across Greater Manchester (doubling time 2.7 days (95% CI: 2.1, 3.7)). The proportion of Omicron in hospital samples follows a similar trajectory to the SGTF proportion in cases, but with a two-day offset. This is consistent with the delay from testing positive to hospital admission, implying a similar proportion of Omicron cases are converting to hospital admissions as for Delta cases. Comparing the Greater Manchester data to national hospitalisation data, similar tends are observed. Therefore, there is no signal of a substantial reduction in hospital admission risk with Omicron, and Omicron epidemics are likely to place a substantial burden on public health infrastructure.

Will I leave work on time today? A quality improvement project

BackgroundDoctors rarely leave work on time;they frequently stay beyond the end of their shift to complete clinical work, documentation and other tasks. This is contributing to burnout and doctors leaving the profession – resulting in those who stay behind, stay even longer!A Quality Improvement project was carried out at a tertiary Neonatal Unit in London. The time doctors stayed back at the end of each shift was recorded, the reasons for staying back were explored, and different change ideas were tested.ObjectivesThe project aimed to explore the reasons why doctors do not leave work on time.The Change Aim: All doctors finish work on time or within 30 minutes of the end of the shift.MethodsThe Model for Improvement was used. Observation, process mapping and a fishbone analysis technique were used to explore the problem.Measure: The time (in minutes) stayed back after each doctors’ shift was due to end, was recorded on a form in the doctors’ room.Change ideas: Eight Plan-Do-Study-Act cycles were trialled:Spreading awareness of behaviourBleep-free handover, to reduce interruptionsOutstanding NIPEs (Neonatal/Infant Physical Examination), causing delay at discharge were highlightedException Reporting discussion at a junior/senior meetingBleep-free Handover trialled againImprove co-ordination on postnatal wards by encouraging joint doctor-midwife ‘huddles’Reduce interruptions on postnatal wardsStart handover earlier on postnatal wardsResultsAn initial run chart showed doctors stayed back a mean of 52 minutes per doctor (Range 0–180 minutes) after their shift was due to end.Over this project, the mean time doctors stayed back at the end of a shift was reduced from 52 minutes to 28 minutes per doctor per shift.The most successful PDSAs were improving co-ordination on postnatal ward, and starting handover earlier.Exception reporting, the main tool for safeguarding working practices is rarely used, despite there being no barriers to do so.A narrative of doctor’s viewpoints showed diverse attitudes including:‘I don’t want to handover rubbish!’‘It’s just a job.’‘I’m lucky to have the job on my terms, I don’t mind staying late.’ (part time trainee).ConclusionsThere was exemplary engagement of seniors during the course of the project. Furthermore, the actual scheduled working hours were within European Working time directives.Staying on beyond the shift pattern produces tired, burnt-out doctors. who are more likely to make mistakes or even leave the profession. Safeguarding work-life balance is an important aspect of doctors’ and ultimately patients‘ well-being. The project demonstrated that multiple small adjustments can improve the efficiency of the working day, enabling doctors to leave work on time.Changes can be considered in three areas.Managing clinical workloadOperational ManagementDoctors views/attitudes (the psychological aspect).The overall aim is to work smarter, not harder. Quality Improvement Methodology is a powerful tool to enable important change to occur in many aspects of the workplace, contributing to betterment of doctors’ work-life balance. This project illustrates this in a novel way. It is now more relevant than ever as the medical profession recovers from the impact of COVID-19.