Toolbox history

Page written in 2012, kept for historical reasons.

Context

New technology and shift patterns have meant that whilst services like pathology and x-ray have got better, handover and referrals have got worse. The administrative burden on junior doctors is greater now than it has ever been and most handover and referral processes are unique to hospital firms. Addressing this challenge, this project began from St Peter’s hospital.

Problem

Poor handovers due to unfamiliarity with the job lead to mistakes and vital administrative tasks being missed or performed badly. A disproportionate amount of time can be spent looking for the right form or trying to find the right person to send it to. Junior doctors ‘rotate’ frequently, ending up in new jobs they are unfamiliar with knowledge lost between cohorts as how best to do the job. Excessive time is spent adapting to the practical aspects of the new job affecting patient care if investigations are ordered incorrectly or there is a delay in a referral. It also means that junior doctors have less time to spend looking after the medical aspects of their patients’ care.

We collected information from a survey of junior doctors at St Peters hospital and found that 7 months after starting at the hospital they still lost on average 40 minutes a day due to unfamiliarity with referrals or forms. It also showed that the main source of information was other doctors, rather than trust guidelines- implying a waste of other doctors’ time. We have found that this problem was not localized to St Peters but a national problem and are implementing this project at St Peters and also other hospitals in the UK.

Primary Aims of the Project

To improve patient safety by facilitating a better handover between rotating doctors
To improve the efficiency (and reduce the stress) of junior doctors by providing a readily accessible site with specific local information on what to expect and how to get things done

Problems Identified and the Reasons behind the Toolbox

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

Getting Jobs Done

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

Ensuring a better handover

Patient safety is compromised, particularly in August, due to poor handover between old doctors and new doctors
It is impossible to verbally handover all of the information between outgoing doctors and incoming doctors
While shadowing periods can help somewhat, there are many unknown questions still uncovered by the end of this period
Paper guides are frequently lost and are cumbersome to carry around
Much helpful information is learnt by doctors throughout the year but it is difficult to communicate these learning points effectively

The Dr Toolbox at your hospital

A website set up and run by Junior Doctors that provides up-to date information relevant to other Junior Doctors within their trust
It includes:
- Handover guides for all F1 firms starting in August
- Bleeps of Doctors in the Hospital both for during the week and out of hours
- Extension numbers for wards, secretaries and other hospitals
- Commonly used reference guides specific to the hospital downloadable to your computer and mobile
- 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
It is:
- Password protected
- Easily updatable
- Specific to Junior Doctors working at their individual hospitals
- Available from the hospital intranet, a home computer or a mobile phone
- Simple to set up for other NHS trusts

Progress so far

The site has been set up for a number of hospitals across the London Deanery as part of the same initiative under the broad umbrella of DAPS.
Access provided to Junior Doctors at each hospital
Link posted on intranet
Advice given about setting it up as an app!
Consultant and IT engagement

Future Plans and Possibilities

Introduction to new F1’s/F2’s in August
Recruit two new F1’s/F2’s to each hospital to have responsibility to maintain and update the site
Use the site as to promote medical education and teaching events
Aim to tailor the site to Core Trainee’s as well (e.g more specifics on medical on-calls/nights etc)
Look to set-up satellite sites in other London Deanery Trusts
- Best time to do this would be before August as people now have the most knowledge
- Simple to do – little technological know-how required
- No direct costs
- Simple to scale to other trusts
- Just requires the engagement of other Doctors interested in patient safety and improving efficiency!