ABSTRACT
BACKGROUND: Changes to the undergraduate medical curriculum now offer a greater focus on community-based teaching, communication skills and medical humanities. Unfortunately, this has been at the expense of surgical teaching. The senior house officer is usually the first port of call when a patient is being referred to a plastic surgery department. Therefore, a reasonable level of knowledge is required with regard to emergency presentations, examination skills, and clinical skills to appropriately manage the injury. The primary aims of this quality improvement project are to firstly improve the newly starting doctor's confidence in undertaking an on-calls in either trauma or burns following the induction programme and to also improve their level of satisfaction. METHODS: The Quality Improvement Project (QIP) team consisted of a Foundation Year 2 doctor, a core surgical trainee, and a registrar. Three Plan, Do, Study, Act (PDSA) cycles were completed to improve the quality of the induction programme. In the first PDSA cycle, junior doctors were provided with a handbook that covered necessary topics regarding burns and plastic surgery. In the second cycle, a structured presentation which included case-based discussions, was incorporated into the trauma aspect of the induction. Finally, in the third cycle, a structured presentation which included case-based discussions, was incorporated into the burns aspect of the induction. Data was collected in the form of a questionnaire one month following the departmental induction for each cycle. The questionnaire assessed the doctor's confidence levels and degree of satisfaction with the induction programme. Students were also given the opportunity to complete written descriptive feedback at the end of the questionnaire. Furthermore, pre- and post-induction questionnaires on the day of induction for the December and April cohort of doctors were also obtained. Results: A total of 16 doctors completed the questionnaires. Overall satisfaction, confidence in undertaking trauma on-calls, and confidence in undertaking burns on-calls improved from 3.84/5, 1.83/5, and 2.67/5 in the first cycle to 4.6/5, 3.6/5, and 3.6/5 in the third cycle, respectively. Satisfaction with the clinical emergencies and case discussions aspect of the induction programme improved from 2.17/5 in the first cycle, to 4.6/5 in the third cycle. With regards to the pre- and post-induction questionnaire on the day of induction, the December cohort's correct answer percentage improved from 58.3% to 94.4%, and the April cohort improved from 47.2% to 93.3%. CONCLUSION: Whilst it is unlikely to completely prepare new junior doctors for the transition into clinical practice in a unique speciality such as burns and plastic surgery, our study highlights the value of a thorough, multi-stage induction in ensuring junior doctors feel confident to deliver high quality and safe patient care.
ABSTRACT
OBJECTIVES: Hospitals have the responsibility of creating, testing and maintaining major incident (MI) plans. Plans emphasise readiness for acceptance of casualties, though often they neglect discharge planning and care for existing inpatients to make room for the sudden influx.After collaboration and design of a discharge policy for a paediatric MI, we aimed to establish the number of beds made available (primary outcome) to assess potential surge and patient flow. We hypothesised that prompt patient discharge would improve overall departmental flow. Flow is vital for sick patients awaiting admission, for those requiring theatre and also to keep the emergency department clear for ongoing admissions. METHOD AND SETTING: A simulated MI was declared at a London major trauma centre. Five paediatric priority 1 and 15 priority 2 and priority 3 patients were admitted. Using live bed boards, staff initiated discharge plans, and audits were conducted based on hospital bed occupancy and discharge capacity. The patients identified as dischargable were identified and folllowed up for 7 days. RESULTS: Twenty-nine ward beds were created (42% of the total capacity). Handwritten summaries just took 13.3% of the time that electronic summaries took for the same patients by the same doctor. In-hospital transfers allowed five critically injured children into paediatric intensive care unit (PICU), and creation of a satellite PICU allowed for an additional six more if needed. CONCLUSION: We increased level 3 capacity threefold and created 40% extra capacity for ward patients. A formalised plan helped with speed and efficiency of safe discharge during an MI. Carbon copy handwritten discharge letters allowed tracking and saved time. Robust follow-up procedures must be in place for any patients discharged.
