Night Time Emergency Department Secondment :

1. Night Time Emergency Department Secondment: An Alternative to Extended Junior Doctor Surgical Cross-Cover in ENT and Beyond? Williams R1, Hope A2 1Institute of Naval Medicine, Gosport, UK. 2MDHU Derriford, Plymouth, UK. Richard.williams8@nhs.net Management Solutions - Increase inter-departmental cross-cover thus diluting the knowledge base of the covering junior doctor - Increase compensatory leave allowing increased frequency of night shifts, which would reduce junior doctor training experience Cycle 1 An audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Hospital at night ward tasks completed - Audit of Emergency Department (ED) consultations and compliance with current Clinical Quality Indicators (CQIs) The Problem - Derriford Hospital is a 900-bed tertiary referral center serving a population of 450,000. - Plastic and ENT Surgery junior doctors cross-cover at night - Aug 2011 saw an enforced reduction in junior doctors from 12 to 10 Background With declining working hours, ever-tighter budgeting and reduced trainee numbers, innovative solutions were required to maintain a specialist knowledge base for ENT care at night. The literature warns of the dangers of increasing surgical cross-cover, resulting in junior doctors covering specialties with inadequate training, working outside their sphere of interest. Cycle 1 Conclusions - ENT/Plastics Surgery junior doctor were underemployed at night - Poor CGIs for ENT/Plastics patients - Large duplication of work with ED and ENT/plastics dual clerking patients - 64% ward tasked were generic - 68% ward tasks were routine INTERVENTION THE SECONDMENT OF THE NIGHT ENT/PLASTICS SURGERY JUNIOR DOCTOR TO THE ED AS THEIR PRIMARY PLACE OF WORK Job Description - Based in ED minors 2100-0700 - See and treat all potential ENT and plastic surgical cases upon presentation - To be re-called for ward tasks according to priority category - To work within a structured system of ED clinical supervision for patients not formally followed up by ENT/plastic surgery services. Further Development - Extension of service framework to other specialties (e.g. orthopedics and psychiatry) and other hospitals. - The establishment of a hospital wide service to deal with generic ward tasks without recalling seconded juniors from ED. - Hospital systems to reduce the amount of routine ward tasks performed at night • Conclusions • PTsreceived more expedient care • PTs seen by more complaint specific clinician • ENT maintained a specialist junior doctor service without increased cross-cover • ENT reduced junior doctor salary expense with ED funding banding change • EDsecured improved CQIs • EDstaff freed of the burden of dual clerking • JUNIORs increased training exposure by 26% • JUNIORSreceived increased salary banding Cycle 3 Further re audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - To assess lasting effect of service Cycle 2 A re-audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - Analysis of impact on exposure to training.