scholarly journals Audit on availability, quality and frequency of clincal and educational supervision

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S79-S79
Author(s):  
Gayathri Gnanasekaram ◽  
Amanda Hoar
Keyword(s):  
Clinical Supervision ◽  
Clinical Work ◽  
Clinical Encounter ◽  
Junior Doctors ◽  
Improvement Project ◽  
Medical Environment ◽  
Clinical Encounters ◽  
Survey Responses ◽  
User Friendly

AimsGMC defines clinical supervisor as a trainer who is responsible for overseeing a specified trainee's clinical work throughout a placement in a clinical or medical environment and is appropriately trained to do so¹.This AUDIT aimed to review the frequency, content and quality of clinical supervision for psychiatric trainees within Somerset NHS Foundation Trust. Both Severn deanery and Somerset NHS Foundation Trust both recommend psychiatry trainees have one hour of supervision per week, involving exploration of trainee clinical and educational needs.MethodAll trainees working in Somerset NHS Foundation Trust psychiatry from February 2020 were invited to participate. A survey was designed to quantify the frequency of supervision amongst this cohort. Survey online software, SurveyMonkey, was chosen for the accessibility and user friendly modality and disseminated via email to all junior doctors (n = 27). Survey responses were collected in the last month of the placement (July–August 2020).Questions on accomplishing workplace based assessments (WPBA), managing e-portfolio requirements were asked, with Likert scale responses available. Quality of supervision was explored via white space answers.Surveys were reviewed by the AUDIT authors and descriptive data collected.Result63% trainees responded (17 out of 27). Educational objectives were discussed at the beginning of the placement. Over half the respondents stated that time was not set aside to look at e-portfolio.Workplace based assessments (WBPAs), and Case based discussions (CBDs) were more frequently achieved than observed assessments of clinical encounters (ACEs/Mini-ACEs) (assessment of clinical encounter).30% core psychiatry trainees respondents (4 out of 7) discussed their audits/QI projects with their supervisors most/always. 42% (3 out of 7) had a discussion sometimes.2 GP and foundation trainees stated they were unable to obtain community mental health experience. The response rate to this question was disappointing and we think it may be secondary to the pressures of the pandemic.100% respondents described educational supervisors as supportive and approachable.ConclusionWhilst all respondents found their supervisors approachable and supportive, completion of formal WPBAs and portfolio reviews was suboptimal.Following regional presentation of results, the pertinence of these findings for all trainees was highlighted. A supervision template has been created and extension of this initial audit to a regional quality improvement project is underway.Specific recommendations included brief and regular supervisor check-ins with trainees regarding projects and psychotherapy competencies and a mid-placement review of portfolio.

524 QUALITY IMPROVEMENT PROJECT: INCORPORATING COMPREHENSIVE GERIATRIC ASSESSMENT INTO COMMUNITY HOSPITAL CLERKING

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii8-ii13
Author(s):  
A Oates
Keyword(s):  
Quality Improvement ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Community Hospital ◽  
Quality Improvement Project ◽  
Junior Doctors ◽  
Medical Team ◽  
Improvement Project ◽  
Efficient Detection ◽  
User Friendly

Abstract Elderly patients transferred to community hospitals often have complex medical, social, psychological, functional and pharmacological backgrounds that require careful assessment in order to create and deliver a high quality, patient-centred care plan. Unfortunately, time pressures experienced by staff in acute hospitals can make Comprehensive Geriatric Assessment (CGA) unfeasible for every patient. Moreover, junior members of the medical team may be unsure as to which aspects of a patient’s background and presentation constitute important elements of a CGA. Failure to recognise and document pertinent issues can lead to prolonged admissions, disjointed care and failed discharges. Admission to a community hospital presents a convenient ‘checkpoint’ in the patient’s hospital journey at which to undertake a CGA. Recording the relevant information in an effective clerking proforma when the patient is admitted ensures that this information is displayed clearly and in a way that is accessible to all members of the multidisciplinary team. The pre-existing clerking proforma at Amersham Community Hospital omitted several important elements of CGA (such as examination of feet and gait, assessment of mood, FRAX-UK score, creation of a problem list etc.) The aim of this quality improvement project was to create a thorough, yet user-friendly and time-efficient clerking proforma which incorporated the important components of CGA. Using BGS guidance and NICE quality standards, alongside suggestions from the medical team, the existing clerking proforma was adapted and reformed. After one month, feedback from the team was used to further improve the clerking proforma, ensuring that it was user-friendly, whilst meeting the standards set out by NICE and BGS. This was repeated as part of a second PDSA cycle. The improved clerking proforma enables junior doctors to undertake a thorough and holistic assessment, promoting efficient detection of issues and the delivery of a higher quality of care.

'Hands on, Hands off': a model of clinical supervision that recognises trainees' need for support and independence

2010 ◽  
Vol 34 (3) ◽  
pp. 286 ◽  
Author(s):  
Rick Iedema ◽  
Suzanne Brownhill ◽  
Mary Haines ◽  
Bill Lancashire ◽  
Tim Shaw ◽  
...  
Keyword(s):  
Clinical Supervision ◽  
Hospital Setting ◽  
Rural Hospital ◽  
Depth Information ◽  
Junior Doctors ◽  
Supervisory Support ◽  
Medical Supervision ◽  
Hands On ◽  
Being There

Rationale.This article presents a study of junior doctor supervision at a rural hospital. The objective of the present study was to gain insight into the types of supervision events experienced, the quality of supervisory relationships, the frequencies of supervision contact in a rural hospital setting, and the implications of these factors for supervision practice. Methods.A cohort of junior doctors was asked to provide in-depth information about their interactions with their supervisors and other relevant clinical colleagues. The information was filled in on diary sheets to capture the nature, focus and quality of the cohort’s supervision experiences over 2 weeks. The information also covered frequency and types of supervisory contacts. Results.The quantitative data reveals that supervisory events occur predominantly as part of ongoing patient care and rarely off-line as part of targeted supervisory practice. The qualitative data analysis reveals that junior doctors value supervisory support of two kinds: assistance from more senior clinicians who are expert in areas where trainees need help, and trust to act independently, without being abandoned. Conclusion.Supervision must be both structured and dynamic. Besides providing a regular forum for discussion and reflection, supervision must accommodate the variable needs of individual junior doctors and navigate between being hands-on and hands-off. Such dynamic approach is necessary to reassure junior doctors they are in a ‘zone of safe learning’ where they can act with adequate and flexible support and negotiate changes in supervisory attention. What is known about the topic?Research is recognising the challenges of treatment complexity and unexpected outcomes faced by junior doctors. These factors mean that supervision needs to include dealing with the experiential and interpersonal aspects of junior doctors’ clinical work. It is also recognised that the supervisory relationship remains to be investigated in depth. Further, because supervision guidelines in Australia are still under development, they do not as yet specify senior doctors’ or registrar’s supervisory accountabilities. Relying on conventional approaches to managing medical supervision, hospitals and associated medical schools are struggling to ensure that supervising doctors’ perceptions of and approaches to supervision are aligned with emerging definitions of effective supervision. What does this paper add?The ‘hands on, hands off’ model developed here enriches post-graduate medical curricula on two fronts. First, it advises supervisors that they need to be hands-on, practising ‘active supervision’. This involves regular and structured contact with junior doctors to enhance the safety and quality of the care provided by them. Second, it advises supervisors to be hands-off, practising ‘passive supervision’. This involves ‘trustful’ monitoring junior doctors’ everyday work and negotiating with them their unique and changing learning trajectories. What are the implications for practitioners?The model proposed here has three implications for practitioners. First, the model posits that medical supervision is about ‘being there’. Junior doctors set great store by being granted ready access to advice and help if and when that is needed. Second, the model emphasises that junior doctors expect to gain supervisors’ trust to act independently albeit with supervisory access and guidance being readily available. Third, junior doctors’ needs change, not necessarily in a linear, uni-directional way. For supervisors, this means that they need to devise regular feedback opportunities for their trainees to articulate their developments, concerns and changing needs.

scholarly journals Improving driving advice provided to cardiology patients on discharge

2018 ◽  
Vol 7 (1) ◽  
pp. e000162
Author(s):  
Amoolya Vusirikala ◽  
Mark Backhouse ◽  
Sarah Schimansky
Keyword(s):  
Hard Copy ◽  
Junior Doctors ◽  
Improvement Project ◽  
The Third ◽  
Driving Restrictions ◽  
Pdsa Cycle ◽  
Before And After ◽  
Ability To Drive ◽  
Discharge Summaries

Certain cardiac conditions can limit patients’ ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors.We therefore designed a quality improvement project using Plan–Do–Study–Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education. After collecting baseline data, we created a template with cardiology-specific DVLA advice. During the second PDSA cycle, we improved the electronic template and also introduced a hard copy on the ward. During the third PDSA cycle, we incorporated information on DVLA guidance in the specialty induction session. We also evaluated junior doctors’ confidence of providing driving advice before and after this intervention.Baseline measurements showed that 10% (9/92) of all discharge summaries included driving advice. This improved to 49% (34/69) after the third PDSA cycle. Importantly, after receiving information on driving advice in the induction, junior doctors felt more confident in providing driving advice to cardiology patients on discharge. In conclusion, the provision of driving advice on discharge is an important element of patient safety. However, clinicians’ knowledge and awareness of current DVLA guidance is often limited. We demonstrated a significant increase in the provision of driving advice by introducing a standardised template.

scholarly journals Communication in COVID: a quality improvement project into staff communication with family/carers at New Haven Older Adult Mental Health Inpatient Unit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S199-S199
Author(s):  
Felicity Jones ◽  
Bhavna Khanna ◽  
Batool Almoosawi ◽  
Alex Humm ◽  
Upjeet Mahon ◽  
...  
Keyword(s):  
Family Involvement ◽  
Family Members ◽  
New Haven ◽  
Power Of Attorney ◽  
Conference Calls ◽  
Improvement Project ◽  
Staff Members ◽  
Survey Responses ◽  
Family Contact

AimsIn the psychiatric care of patients, family involvement is key to recovery. At the New Haven Unit, there have been a number of complaints regarding poor communication and lack of updates given to families during COVID-19.The aim is to:To increase the overall satisfaction of the family with the service received for their loved onesEnsure effective and timely communication of updates to the families, to prevent further complaints, by assigning a member of staff per patient to be the primary individual responsible for family contactCreate an addition to the weekly ward round MDT proforma on ‘Carenotes’ where communication can be documentedMethodA standardised questionnaire has been sent to the relatives of inpatients at the New Haven Unit. Qualitative data are being collated, which will lead to quantitative statistical analysis of the satisfaction ratings.Based on the current bed state on the ward at the time of the project all 32 relatives of current inpatients were contacted and 23 agreed to complete the survey which was sent out either by email or post.The new MDT proforma will be added, which will be used to record actions needed to be taken involving communication and updating family members on a weekly basis. This opportunity to record communication will improve continuity of care and satisfaction amongst family members.There will be follow-up via a second questionnaire to identify improvement.ResultThe average results of selected categories so far are shown below (still awaiting further responses):Frequency of updates regarding loved ones = 4.33/10 (10-excellent)To what degree were your concerns listened to? 7.33/10Quality of content discussed with staff members = 3.33/4 (4- excellent)Other categories scoring below the expected standard, included awareness of visiting guidelines and questions regarding lasting power of attorney, in which 33.3% of participants responded either ‘no’ or ‘not sure’ respectively.Questions addressing formalities of introduction and confidentiality through identity confirmation, scored highly.ConclusionWe are awaiting more survey responses in order to identify additional areas of improvement; however, it is already clear to see that there are areas that would be advanced through structured, assigned reminders via an MDT amendment.We will also be introducing set dates for conference calls with the families now involving the whole MDT; one within the first week of admission, one after six weeks and one at the point of discharge as a minimum.

WED 268 Improving junior doctors induction: queen square junior doctors handbook

2018 ◽  
Vol 89 (10) ◽  
pp. A39.2-A39
Author(s):  
Al-Mayhani Talal ◽  
Khalil Aytakin
Keyword(s):  
Quality Improvement ◽  
Medical Staff ◽  
Clinical Information ◽  
Junior Doctors ◽  
Information Contact ◽  
Improvement Project ◽  
Assessment Approach ◽  
Participatory Assessment ◽  
General Guidance

IntroductionAll junior doctors joining Queen Square undergo an induction package delivered along with the Queen Square Junior Doctors’ Handbook (QS-H). QS-H is supposed to provide general guidance to daily medical jobs in addition to useful clinical information, contact details and hints.AimThe aim of this quality improvement project (QIP) was to update, and improve, the quality of QS-H. The idea was that better and more informative induction can make carrying out daily jobs easier, increase the efficacy/effectiveness of medical staff and, ultimately, impact positively on patients care.MethodsIn this QIP a participatory assessment approach was employed where the opinions of the beneficiaries (junior doctors) were sought to screen for the strengths/weaknesses of the old version of QS-H, and to assess, later on, the new version.Results and conclusionMost junior doctors highlight the length of QS-H and the outdated information of its contents. Based on their suggestions a new, brief and practical version was drafted and was well received with some comments that led to additional round of improvement. Distributing hardcopies of QS-H around the wards further improved the junior doctors’ accessibility, efficiency, effectiveness and satisfaction.

scholarly journals Microsoft teams virtual handover system

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S209-S209
Author(s):  
Mohit Mohan ◽  
Ruth Scally ◽  
James Reed ◽  
Calin Cavaropol
Keyword(s):  
Psychiatric Hospitals ◽  
Clinical Information ◽  
Daily Basis ◽  
Junior Doctors ◽  
Early Completion ◽  
Staff Members ◽  
Handover Process ◽  
User Friendly ◽  
Inpatient Units

AimsAccurate and timely handover of clinical information is of great importance to continuity and safety of care. Psychiatry doctors typically cover a number of sites across a catchment when they are on-call. Consequently, handover between on-call teams and day teams in psychiatric hospitals is reliant on using the nursing staff as an intermediary to flag concerns or relying on the day teams proactively checking the notes on daily basis for outstanding tasks.The key objective of this project was to use Microsoft teams to establish a handover system that is efficient, safe, reliable, easy to use and replicable.MethodA microsoft teams group was created comprising of all the medical staff members working at inpatient units across three sites that are part of Birmingham and Solihull Mental Health Trust. These members were divided into two groups - the ‘on-call team’ and the ‘day team’. Within the ‘day team’, every consultant was grouped with their junior doctors to form multiple subgroups.A system was established wherein the two teams could communicate with each other by posting a message and tagging the appropriate team. A provision was made to create a channel for every ward to allow for easy segregation and monitoring of tasks.Qualitative information about the use of the tool was monitored by monthly focus group meetings. A formal review of the messages was conducted after 8 weeks to assess the following parameters:Number of messages postedNumber of messages acknowledgedNumber of safety-related incidentsResultInitial evaluation of the results suggests that the new handover system was perceived to be safe, accurate and efficient while being intuitive and hassle-free. This increased the quantity and enhanced the quality of communication between the ‘on-call’ and the ‘day teams’ and allowed for early completion of tasks while reducing the number of safety-related incidents.ConclusionThe Microsoft teams proved to be a viable alternate tool to create a virtual handover process that is efficient, safe, reliable and user-friendly. It also has the potential to enhance the communication between inpatient and community teams.

scholarly journals 919 Surgical Voice Restoration – Improving Out of Hours Management: A Multidisciplinary Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
J McCord ◽  
B Roberts ◽  
S Browning
Keyword(s):  
Junior Doctor ◽  
Working Hours ◽  
Standard Of Care ◽  
Junior Doctors ◽  
Health Board ◽  
Contributing Factors ◽  
Improvement Project ◽  
Out Of Hours ◽  
Voice Restoration

Abstract Aim Swansea Bay University Health Board have a caseload of 37 surgical voice restoration (SVR) laryngectomies. These patients are excellently managed during working hours, by a SALT-led service. Concerns were raised regarding the quality of out of hours management: the aim of this project was to identify and address the factors contributing to the difference in care received. Method A questionnaire was sent to current junior doctors to assess knowledge and confidence when managing SVR patients. Phone interviews were conducted with SVR patients to discuss the issues from a patient’s perspective. The junior doctor team and SALT team liaised to identify contributing logistical issues. Results The junior doctor survey indicated both experience and confidence were low, including amongst senior trainees. 58.3% were unfamiliar with equipment used to change a speech valve. Patient interviews revealed several issues, such as delays to treatment and unnecessary admissions. Logistical concerns included inability to access equipment out of hours and an absence of departmental guidelines. Conclusions This project demonstrates a collaborative approach between junior doctors and SALT, to improve the quality of care for a sub-set of patients with highly specialised needs. We identified the contributing factors for the disparity in services and tailored interventions to provide the junior doctors responsible for out of hours care, with the knowledge and skills to provide a better standard of care.

Simulation and Emulation Tools for Fog Computing

2020 ◽  
Vol 13 ◽  
Author(s):  
Simar Preet Singh ◽  
Rajesh Kumar ◽  
Anju Sharma ◽  
S. Raji Reddy ◽  
Priyanka Vashisht
Keyword(s):  
Quality Of Service ◽  
Programming Languages ◽  
Traffic Management ◽  
Fog Computing ◽  
Research Work ◽  
Research Experience ◽  
Computing Paradigm ◽  
Quality Of Service Parameters ◽  
User Friendly

Background: Fog computing paradigm has recently emerged and gained higher attention in present era of Internet of Things. The growth of large number of devices all around, leads to the situation of flow of packets everywhere on the Internet. To overcome this situation and to provide computations at network edge, fog computing is the need of present time that enhances traffic management and avoids critical situations of jam, congestion etc. Methods: For research purposes, there are many methods to implement the scenarios of fog computing i.e. real-time implementation, implementation using emulators, implementation using simulators etc. The present study aims to describe the various simulation and emulation tools for implementing fog computing scenarios. Results: Review shows that iFogSim is the simulator that most of the researchers use in their research work. Among emulators, EmuFog is being used at higher pace than other available emulators. This might be due to ease of implementation and user-friendly nature of these tools and language these tools are based upon. The use of such tools enhance better research experience and leads to improved quality of service parameters (like bandwidth, network, security etc.). Conclusion: There are many fog computing simulators/emulators based on many different platforms that uses different programming languages. The paper concludes that the two main simulation and emulation tools in the area of fog computing are iFogSim and EmuFog. Accessibility of these simulation/emulation tools enhance better research experience and leads to improved quality of service parameters along with the ease of their usage.

scholarly journals 49 A Quality Improvement Project to Assess and Refine the Handover Process at Morning Trauma Meetings

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
S Sadiq ◽  
M Tahir ◽  
I Nur ◽  
S Elerian ◽  
A Malik
Keyword(s):  
Categorical Variables ◽  
Next Of Kin ◽  
Chi Square ◽  
Neck Of Femur ◽  
Improvement Project ◽  
Handover Process ◽  
Neck Of Femur Fracture ◽  
The Impact ◽  
Standard Operating Protocol

Abstract Introduction Poor handover between shifts can result in patient harm. This study was designed to evaluate the impact of implementing a handover protocol on the quality of information exchanged in the trauma handover meetings in a UK hospital. Method A prospective single-centre observational study was performed at an NHS Trust. Ten consecutive weekday trauma meetings, involving 43 patients, were observed to identify poor practices in handover. This data was used in conjunction with the Royal College of Surgeons’ recommendations for effective handover (2007) to create and implement a standard operating protocol (SOP). Following its implementation, a further 8 consecutive meetings, involving a further 47 patients, were observed. The data was analysed using t-test for quantitative variables and chi-square or Fisher’s exact tests for categorical variables. Results An improvement was demonstrated in multiple aspects of trauma handover including past medical history, injury date, results, diagnosis, consent, mark, and starvation status (all p < 0.001). Subgroup analyses showed that handover of neck-of-femur fracture patients including information on baseline mobility (p = 0.04), Nottingham-Hip-Fracture Score (p = 0.01), next-of-kin discussion (p = 0.075) and resuscitation status (p = 0.001) all improved following the intervention. Conclusions These results demonstrate that the implementation of a well-structured handover protocol can improve the transmission of critical information in trauma meetings.

450 Retrospective Analysis of Surgical Clerk-Ins Within the Acute Receiving Unit: A Quality Improvement Project

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
L Lee ◽  
A MacLeod ◽  
A Bradley
Keyword(s):  
Royal Infirmary ◽  
Improvement Project ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
Vte Prophylaxis ◽  
Care Services ◽  
Documentation Quality ◽  
Patient Documentation ◽  
Patient Handovers

Abstract Introduction Accurate patient documentation at the ARU is vital to patient safety and ensuring smooth handovers to secondary care services. Because the nature of surgical treatment requires frequent patient handovers, and this increases the risk of miscommunication, we aimed to assess the quality of surgical clerk-ins and identify areas for improvement. Method Emergency admissions at the Dumfries Galloway Royal Infirmary were audited, looking at documentation quality under various clerk-in sections. Data was analysed before presentation to clinical governance. Results When 46 patient clerk-ins were examined, venous thromboembolism (VTE) prophylaxis plans were performed in only 24% of admissions - less than 1 in 4 patients. Comparing out-of-hours and in-hours patient documentation, much higher omission rates were identified in the out-of-hours documentation: in systemic enquiry (42 vs 100%) and family history (31% vs 66%). Conclusions These results brought to attention the effect of hospital admission timing on patient documentation quality, and the lack of VTE prophylaxis planning. In surgery, these plans are key to minimising risk of avoidable thromboembolic complications. A departmental meeting was convened to stress the importance of accurate and comprehensive clerk-ins to ARU doctors. Future audits could explore the factors influencing documentation quality for out-of-hours admissions, and ways to address these issues.

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