Communication in Acute General Medicine

1. Learning To Make a Difference Communication in Acute General Medicine Bernadette Young ST2 Oxford University Hospitals

2. Project Aim Learning To Make a Difference • Improve to >90% the proportion of nurses on medical wards who can identify the correct doctor to bleep on a Saturday or Sunday, following a change to the system • Previous arrangement for medical ward cover: • Monday to Friday, 9-5: own medical team, all other times: 4160/4163 • Since November 2011 • Monday to Friday, 9-5: own medical team • Mon-Fri 5pm to 9am, and Sat and Sun 9:30pm to 9am: 4160/4163 • Sat and Sun 9am-9:30pm: on call team, determined by own firm, carrying usual bleeps Oxford University Hospitals

3. Act Plan Study Do Learning To Make a Difference Action Planning Oxford University Hospitals

4. Learning To Make a Difference Process mapping • Many not aware of list/new weekend • working arrangements and tried to use • night on call bleep • The process of identifying consultant • and firm number hits several barriers • (not recorded on WR entries, handover • of firms means this changes over time) • Nurses not regular on the wards did • not know of ‘firm numbers’ • The initial bleep list featured firm number • only and not consultant name Oxford University Hospitals

5. Learning To Make a Difference Factors at play Oxford University Hospitals

6. Learning To Make a Difference Tests of Change • Cycle 1 • Identified factors that made weekend bleep list difficult to use/access • Redesign the weekend bleep list (clearer, more information) • Distribute weekly to be prominently displayed on each medical ward • Audit proportion of nurses who could identify correct bleep for a given patient • Improvement found, but limited by quality of documentation in notes • Cycle 2 • Identified a clear, reliable way for medical teams to document the responsible team • Designed and distributed stickers for each team to place in notes prior to weekend • Audit proportion of notes where the responsible team was clearly documented (in post-take Ward Round note, in Ward Round or in either) • Improvement found, but limited by decline in documentation elsewhere in the notes Oxford University Hospitals

7. Learning To Make a Difference Runchart – cycle 1 Oxford University Hospitals

8. Learning To Make a Difference Runchart – cycle 2 Oxford University Hospitals

9. What difference has beenmade? Learning To Make a Difference • Proportion of nurses who could correctly bleep the doctor responsible for a patient improved from 45% to 90%, this was sustained • Overall proportion of notes with responsible team clearly documented fell slightly (90 to 85%) due to poor take up and decline in documentation standard overall Oxford University Hospitals

10. Next Steps Learning To Make a Difference • Presentation at clinical governance for discussion • Identifying an administrative staff member to take over • Complex ward cover system, organisational changes would be needed to simplify it (central/electronic ‘bleep’ system, ward based care) • Recommendations: • One problem may be a marker of larger overall quality problem • Before implementing a complex change to working patterns, find out how it will impact on other professionals • Think again before you choose a project that involves regularly auditing out of hours working Oxford University Hospitals

11. Team Members Learning To Make a Difference • Dr Bernadette Young (ST2) • Arlene Wellman (matron) • Dr Chris Bunch (clinical lead AGM) Oxford University Hospitals