scholarly journals Does a limited nurse triage service reduce junior doctor psychiatric on-call workload?

2004 ◽  
Vol 28 (10) ◽  
pp. 368-370 ◽  
Author(s):  
A. P. Moore ◽  
S. Willmott

Aims and MethodTo investigate whether nurse triage might reduce junior doctors' on-call workloads in a general adult psychiatry in-patient unit, we measured changes in workload after the introduction of a limited (overnight and weekend mornings) nurse triage service on the unit, comparing pre-triage work levels with levels 1 year later. This time frame allowed the new service to settle in, and controlled for seasonal variations in workload.ResultsThe number of ‘work episodes' went up, especially during the night shifts, but the average length of each episode went down (both statistically significant, P < 0.001). The net result was a slight increase in workload in terms of total time spent dealing with episodes, most notably at night.Clinical ImplicationsA limited overnight nurse triage service was ineffective on its own as a means of reducing the out-of-hours workload of junior doctors, and even slightly increased it. A more comprehensive triage service, with a greater range of alternatives to admission, might have had a different result.

2013 ◽  
Vol 37 (8) ◽  
pp. 272-275
Author(s):  
Laura Boyd ◽  
Colin Crawford ◽  
Eugene Wong

Aims and methodWe examined the impact of implementing a new Acute Mental Health Emergency Assessment Protocol (AMHEAP) on joint psychiatric assessments out of hours within Forth Valley, Scotland, over the course of 4 calendar months. The protocol states that assessments should be carried out by a junior doctor and a registered, qualified mental health nurse. The impact measures were taken as admission rates and experience of the doctor in training.ResultsIn the 4 months that were examined (1 June–30 September 2011), 79.5% of out-of-hours emergency assessments were performed jointly. Admission rates were significantly decreased (P<0.001) compared with a similar period in 2008, before the AMHEAP protocol was developed. Most junior doctors valued the experience of joint assessment.Clinical implicationsJoint assessment can enhance patient experience, reduce hospital admission, and provide a learning opportunity for junior doctors in emergency psychiatric assessments. However, it represents a move away from the doctor as sole decision maker.


2021 ◽  
Vol 10 (3) ◽  
pp. e001482
Author(s):  
Derya Tireli ◽  
Michael Broksgaard Jensen

The workflow in a stroke unit can be very high, and this is especially noticeable during evening and night shifts, where staffing is reduced but the patient’s need for frequent and intensive care is not. The specialised and standardised settings in a stroke regime are constant and demanding for healthcare providers who, therefore, must work efficiently. Patient admissions, acute situations and routine tasks are major contributors to the burden of work during evening and night shifts for junior doctors on call. Thus, it is important to reduce the number of potentially avoidable tasks done by these junior doctors during night shifts so they have more time to perform tasks of high priority. The aim of this project was to reduce the potentially avoidable tasks occurring at night for the on-call junior doctor to only one per shift. We investigated the types of tasks that frequently occur for the on-call junior doctor during the night shift and improved our daily morning and evening rounds to reduce the number of tasks during the night shift. Using the plan–do–study–act method, we made improvements through education, knowledge sharing, checklists and feedback, and we reduced the number of potentially avoidable tasks for on-call junior doctors from a median of 11 to a median of 3 per week, demonstrating that the workload for the on-call junior doctor during the night shift can be reduced through a systematic approach to improving the work routines of doctors and nurses.


2006 ◽  
Vol 88 (9) ◽  
pp. 318-319
Author(s):  
MBS Brewster ◽  
R Potter ◽  
D Power ◽  
V Rajaratnam ◽  
PB Pynsent

For the last few years all the hospitals in the UK have been changing junior doctors' rotas to become compliant with the European Working Time Directive (EWTD). The first stage, requiring a junior doctor to work a maximum of 58 hours per week averaged over a 6-month period, became law in August 2004. In addition to new posts for junior doctors there have been schemes to facilitate the transition, such as the Hospital at Night programme. This was designed to use the minimum safe number of doctors from appropriate specialties with supporting medical staff to cover the hospital out of hours. It was required to make the most efficient use of this team and allow the junior doctor rotas to be compliant with the appointment of as few new posts as possible.


2017 ◽  
Vol 41 (6) ◽  
pp. 337-340
Author(s):  
Michael Rutherford ◽  
Mark Potter

Aims and methodSouth West London and St George's Mental Health NHS Trust developed a system of weekend new patient reviews by higher trainees to provide senior medical input 7 days a week. To evaluate the effectiveness of these reviews, the notes for all patients admitted over 3 months were examined. The mean length of stay for patients before and after the introduction of the weekend new patient reviews were compared via unpaired t-test.ResultsA total of 88 patients were seen: 84.4% of patients were seen within 24 h of admission. Higher trainees instituted some changes in 78.9% of patients. The most frequent action was to modify medication, in 47.8%. The average length of stay after the introduction of weekend reviews was not significantly different.Clinical implicationsWeekend reviews of newly admitted patients by higher trainees is a feasible method for providing senior input to patients admitted out of hours.


2001 ◽  
Vol 25 (8) ◽  
pp. 310-313 ◽  
Author(s):  
Judy Harrison ◽  
Nooreen Alam ◽  
John Marshall

Aims and MethodHome treatment offers an alternative to in-patient care, but little has been written about the practicalities of running such a service. Using routine information sources, details of referral and outcome are presented for patients assessed by a home treatment service over 6 months.ResultsForty-eight per cent of referrals were not accepted, mainly because of lack of cooperation, risk to self or others or the illness not being acute enough. Referrals from junior doctors and accident & emergency were least likely to be accepted. Seventy-two per cent of patients accepted suffered from schizophrenia, bipolar affective disorder or depression with psychosis, similar to the diagnoses for in-patients. Twenty per cent of patients accepted had to be transferred to in-patient care later.Clinical ImplicationsStaffing levels need to take account of time spent assessing patients. Junior doctors need training in how to use home treatment services appropriately and a wider range of options are needed to manage patients in crisis out of hours. It is possible to target patients with severe mental illness in a home treatment setting, but a significant number will need transfer to inpatient care.


2017 ◽  
Vol 12 (6) ◽  
pp. 377-382
Author(s):  
Alex Till ◽  
Elizabeth Jane Shaw ◽  
Bethan Royles ◽  
Malik Banat ◽  
Krishna Singh ◽  
...  

Purpose Junior doctors rotating through psychiatry often practise in isolated environments with little prior experience in this field. This can cause anxiety amongst doctors, and may potentially lead to patient safety concerns. The paper aims to discuss these issues. Design/methodology/approach A novel peer-led simulation style teaching session was developed to improve junior doctor knowledge and confidence when working with psychiatry rotations out of hours. Findings Following successful completion of two iterations of the teaching, junior doctors reported increased confidence, reduced anxiety and a more positive attitude following the session. Facilitators were similarly positive in their feedback, being able to gain formal teaching experience and appraisal. Originality/value A novel, inexpensive and easily replicable teaching session is introduced, which can improve junior doctors’ practice and experience when working in psychiatry settings out of hours.


2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
J McCord ◽  
B Roberts ◽  
S Browning

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.


2016 ◽  
Vol 11 (3) ◽  
pp. 144-155
Author(s):  
Kassia Lowe ◽  
Fiona Hynes

Purpose – The purpose of this paper is to address and understand recruitment difficulties into psychiatry; however, to date there is no published research with respect to forensic psychiatry. Forensic psychiatry has always been considered to be a popular specialty amongst junior doctors and therefore the recent trend in local unfilled core training (CT) (junior doctor) posts and national reduced competition ratios for higher specialist training has triggered concern. The impact vacant CT posts within the Forensic Service may have on the future workforce must be considered. Further understanding of this trend is required. Design/methodology/approach – A short statement-style survey addressing attitudes and opinions with respect to the field of forensic psychiatry was devised and distributed to all West Midlands core psychiatry trainees who attended post-graduate teaching (November 2014). Findings – Response rate was 64 per cent. In total, 52 per cent of participants expressed an interest in the specialty, but only 13 per cent wished to pursue a career in forensic psychiatry. In total, 68 per cent of responses deemed forensic psychiatry to be a demanding speciality, with over 50 per cent perceiving forensic patients as difficult to work with. There were high rates of uncertain responses with respect to specialty work life. In total, 78 per cent of responses considered experience of the specialty to be useful. Research limitations/implications – The method chosen to distribute the survey maximised response rate, but may have introduced a Hawthorne effect, as well as response bias, with the visual presence of the researcher. Participants were limited to those who attended teaching on the specified day. This could potentially skew results with an absence of opinions of non-attenders. It may be that characteristics and therefore attitudes and opinions of these two groups are different. A further limitation of the study is that opinions explored are limited to statements included within the survey. Practical implications – The current views may represent stigma, negative media portrayal and misinformed opinions. Action must be taken to increase understanding, interest and experience. Increased exposure to the specialty needs to occur. This could occur as early as high school, using case-study exercises and career sessions. Teaching sessions, summer school placements and elective opportunities should be made available for medical students. At post-graduate level, taster days as well as earlier access to rotations may be a way forward. Originality/value – Although entry into Forensic Higher Training remains comparatively competitive, the potential impact of vacant junior doctor (CT) posts within the speciality is concerning. This is likely to negatively influence recruitment into higher training, which may ultimately lead to decreased numbers of qualified forensic psychiatrists. Specialised care for such a risky and challenging patient group could thus be significantly compromised in the near future. Hence, it is vital to understand the current trend in order to act pre-emptively and address the underlying problems. To date no such research has been conducted.


2006 ◽  
Vol 88 (2) ◽  
pp. 66-68 ◽  
Author(s):  
AK Arya ◽  
KP Gibbin

The European Working Time Directive (EWTD) has led to a reduction in the number of hours that a junior doctor is allowed to work. The Hospital at Night project aims to reduce juniors' presence at night through more efficient working. Otolaryngology has been considered to be one of the surgical specialties in which generic junior doctors covering more than one specialty could effectively function. The hope is to reduce junior doctors' hours sufficiently without compromising their training or patient safety.


BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S28-S29
Author(s):  
Charlotte Harrison ◽  
Helen Blamey ◽  
Alistair Roddick ◽  
Kate Saunders ◽  
Tina Malhotra

AimsOut-of-hours (‘on-call’) work can be perceived by junior doctors to be a daunting experience, associated with feeling unprepared and less supported. Simulated on-call programmes have been used to great effect in medicine and surgery to improve junior doctors’ skills in task prioritisation, interpersonal communication and confidence on-call. However, few psychiatry-specific programmes exist.We aimed to: i) Develop a psychiatry specific virtual-on-call programme, ii) Investigate if the virtual-on-call programme improved confidence amongst junior trainees in key areas of psychiatry practice.MethodThe Psychiatry Virtual-On-Call programme commenced in December 2020. It involves attending an introductory on-call lecture, followed later in the rotation by a 2-hour simulated on-call shift. All trainees are expected to attend during their attachment and the simulated shifts are ongoing. During the shift, trainees are ‘bleeped’ with different psychiatry specific tasks. They work through the tasks, using local intranet policies and telephone advice from the on-call psychiatry registrar. Due to COVID-19 the sessions were delivered virtually. Participants completed a questionnaire evaluating confidence in ten domains, rated on a Likert scale from 0–10. Questionnaires were completed at four time-points during the programme; pre- and post-introductory lecture and pre- and post-simulated shift. Scores were compared using Mann-Whitney U tests. Significance was defined as P < 0.05 with Bonferroni correction applied for multiple testing.ResultTwenty-nine trainees attended the introductory lecture, 25 and 21 trainees completed the pre- and post-lecture questionnaire respectively. A non-significant improvement in confidence was reported in three domains: seclusions reviews, prescribing, detention under the mental health act.At the time of writing, ten trainees had attended the on-call shift. All participants completed a pre- and post-session questionnaire. The on-call shift was a useful learning experience (median score 9), and significantly increased perceived preparedness for on-call work from 3/10 to 7/10 (p < 0.001). Confidence was significantly improved in seven domains, most markedly in seclusion reviews, prescribing and mental health act tasks.ConclusionThe psychiatry virtual-on-call programme fills a niche in the training curriculum and is perceived by trainees to be a useful learning experience. The introductory lecture improved confidence in several domains, but not as effectively as the on-call shift. The on-call shift was well received by participants and significantly improved confidence in 7/10 domains. In summary, the virtual-on-call experience improves preparedness for out-of-hours psychiatry work. Follow-up of participants at the end of their psychiatry rotation will ascertain if they felt the programme to be useful during out-of-hours work.


Sign in / Sign up

Export Citation Format

Share Document