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junior doctor quality improvement

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https://www.readbyqxmd.com/read/28173796/identification-of-factors-that-support-successful-implementation-of-care-bundles-in-the-acute-medical-setting-a-qualitative-study
#1
Stuart A Green, Derek Bell, Nicholas Mays
BACKGROUND: Clinical guidelines offer an accessible synthesis of the best evidence of effectiveness of interventions, providing recommendations and standards for clinical practice. Many guidelines are relevant to the diagnosis and management of the acutely unwell patient during the first 24-48 h of admission. Care bundles are comprised of a small number of evidence-based interventions that when implemented together aim to achieve better outcomes than when implemented individually. Care bundles that are explicitly developed from guidelines to provide a set of related evidence-based actions have been shown to improve the care of many conditions in emergency, acute and critical care settings...
February 7, 2017: BMC Health Services Research
https://www.readbyqxmd.com/read/28123748/the-e-crabel-score-an-updated-method-for-auditing-medical-records
#2
Tharsika Myuran, Oliver Turner, Bijan Ben Doostdar, Bryony Lovett
In 2001 the CRABEL score was devised in order to obtain a numerical score of the standard of medical note keeping. With the advent of electronic discharge letters, many components of the CRABEL score are now redundant as computers automatically include some documentation. The CRABEL score was modified to form the e-CRABEL score. "Patient details on discharge letter" and "Admission and discharge dates on discharge letter" were replaced with "Summary of investigations on discharge letter" and "Documentation of VTE prophylaxis on the drug chart"...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27938372/mapping-the-decision-pathways-of-acute-infection-management-in-secondary-care-among-uk-medical-physicians-a-qualitative-study
#3
Timothy Miles Rawson, Esmita Charani, Luke Stephen Prockter Moore, Bernard Hernandez, Enrique Castro-Sánchez, Pau Herrero, Pantelis Georgiou, Alison Helen Holmes
BACKGROUND: The inappropriate use of antimicrobials drives antimicrobial resistance. We conducted a study to map physician decision-making processes for acute infection management in secondary care to identify potential targets for quality improvement interventions. METHODS: Physicians newly qualified to consultant level participated in semi-structured interviews. Interviews were audio recorded and transcribed verbatim for analysis using NVIVO11.0 software. Grounded theory methodology was applied...
December 12, 2016: BMC Medicine
https://www.readbyqxmd.com/read/27933150/implementing-mobile-devices-to-reduce-non-rostered-workload-for-junior-doctors
#4
Allan Plant, Suzanne Round, Joe Bourne
There is a large body of evidence demonstrating the detrimental effect of long work hours on the performance, mood, and job satisfaction of junior doctors. By extension these effects carry over into the realm of patient safety, compromising the quality of care provision. House officers in the general surgery department of Tauranga Hospital, New Zealand are often required to arrive at work well before their rostered start time of 7.30am to hand write the results of clinical investigations on their patient lists...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27890870/improving-the-quality-of-postgraduate-education-in-traditional-japanese-kampo-medicine-for-junior-residents-an-exploratory-survey-conducted-in-five-institutions-in-the-tohoku-area
#5
Shin Takayama, Seiichi Kobayashi, Soichiro Kaneko, Masao Tabata, Shinya Sato, Keiichi Ishikawa, Saya Suzuki, Ryutaro Arita, Natsumi Saito, Tetsuharu Kamiya, Hitoshi Nishikawa, Yuka Ikeno, Junichi Tanaka, Minoru Ohsawa, Akiko Kikuchi, Takehiro Numata, Hitoshi Kuroda, Michiaki Abe, Satoru Ishibashi, Nobuo Yaegashi, Tadashi Ishii
Traditional Japanese (Kampo) medicine has been widely applied in general medicine in Japan. In 2001, the model core curriculum for Japanese medical education was revised to include Kampo medicine. Since 2007, all 80 Japanese medical schools have incorporated it within their programs. However, postgraduate training or instruction of Kampo medicine has not been recognized as a goal for the clinical training of junior residents by Japan's Ministry of Health, Labour and Welfare; little is known about postgraduate Kampo medicine education...
2016: Tohoku Journal of Experimental Medicine
https://www.readbyqxmd.com/read/27853623/developing-the-gripes-tool-for-junior-doctors-to-report-concerns-a-pilot-study
#6
S Carr, T Mukherjee, A Montgomery, M Durbridge, C Tarrant
BACKGROUND: Junior doctors often have concerns about quality and safety but show low levels of engagement with incident reporting systems. We aimed to develop and pilot a web-based reporting tool for junior doctors to proactively report concerns about quality and safety of care, and optimise it for future use. METHODS: We developed the gripes tool with input from junior doctors and piloted it at a large UK teaching hospital trust. We evaluated the tool through an analysis of concerns reported over a 3-month pilot period, and through interviews with five stakeholders and two focus groups with medical students and junior doctors about their views of the tool...
September 29, 2016: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/27756489/surveillance-of-infection-associated-with-external-ventricular-drains-proposed-methodology-and-results-from-a-pilot-study
#7
H Humphreys, P Jenks, J Wilson, V Weston, R Bayston, C Waterhouse, A Moore
BACKGROUND: The insertion of external ventricular drains (EVDs) is necessary in some neurosurgical patients, but increases the risk of meningitis/ventriculitis. While there are well-recognized risk factors, the proportion of patients who develop meningitis/ventriculitis varies partly due to differences in definitions. A multi-disciplinary working group was established to agree definitions for EVD-associated meningitis/ventriculitis, and a surveillance system was piloted in four centres in the UK and Ireland...
February 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/27726906/the-factors-that-influence-junior-doctors-capacity-to-recognise-respond-and-manage-patient-deterioration-in-an-acute-ward-setting-an-integrative-review
#8
Adele Callaghan, Leigh Kinsman, Simon Cooper, Natalie Radomski
OBJECTIVES: Junior doctors are frequently the first doctor to be called by a nurse to review patients whose clinical status has declined in hospital wards, yet little is known about how well prepared they are to deal with this situation. This paper aims to identify the factors that influence junior doctors' early recognition and management of patient deterioration in an acute ward settings. METHOD: Integrative review methodology was used to allow for the inclusion of broad research designs, summarising current knowledge from existing research and identify gaps in the literature...
October 7, 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/27716183/development-of-a-video-based-education-and-process-change-intervention-to-improve-advance-cardiopulmonary-resuscitation-decision-making
#9
Nicholas Waldron, Claire E Johnson, Peter Saul, Heidi Waldron, Jeffrey C Chong, Anne-Marie Hill, Barbara Hayes
BACKGROUND: Advance cardiopulmonary resuscitation (CPR) decision-making and escalation of care discussions are variable in routine clinical practice. We aimed to explore physician barriers to advance CPR decision-making in an inpatient hospital setting and develop a pragmatic intervention to support clinicians to undertake and document routine advance care planning discussions. METHODS: Two focus groups, which involved eight consultants and ten junior doctors, were conducted following a review of the current literature...
October 6, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27708005/leadership-and-the-medical-registrar-how-can-organisations-support-these-unsung-heroes
#10
REVIEW
Tim Blake, Andrew Whallett
Medical registrars have been described as the 'workhorses' of National Health Service hospitals, being at the interface of acute and chronic health services. They are expected to demonstrate effective leadership skills. There are concerns from the Royal College of Physicians that medical registrars are being overwhelmed and unsupported by organisations, and are struggling in their ability to provide safe, high-quality patient care. Junior colleagues are also being deterred by general medical specialties by the prospect of becoming the 'Med Reg'...
December 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27651898/improving-communication-between-phlebotomists-and-doctors-a-quality-improvement-project
#11
Emma Saunsbury, Gabrielle Howarth
Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27530343/mobile-learning-devices-in-the-workplace-as-much-a-part-of-the-junior-doctors-kit-as-a-stethoscope
#12
Rebecca Dimond, Alison Bullock, Joseph Lovatt, Mark Stacey
BACKGROUND: Smartphones are ubiquitous and commonly used as a learning and information resource. They have potential to revolutionize medical education and medical practice. The iDoc project provides a medical textbook smartphone app to newly-qualified doctors working in Wales. The project was designed to assist doctors in their transition from medical school to workplace, a period associated with high levels of cognitive demand and stress. METHODS: Newly qualified doctors submitted case reports (n = 293) which detail specific instances of how the textbook app was used...
August 17, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27493746/improving-pre-emptive-prescribing-to-relieve-patient-discomfort-occurring-out-of-hours
#13
Rhys Williams, Fiona Herbert, Amy Orme, Georgina Casswell
Junior doctors are commonly asked to prescribe simple medications for symptom relief for patients out of hours. Unfortunately, time constraints and other pressures may lead to delays before the medications are prescribed. A quality improvement project was conducted at a large university teaching hospital to establish the extent of the problem, with the aim of finding measures to improve preemptive prescribing for patients. Baseline data was gathered over three busy wards to calculate the total of new prescriptions made over the course of a weekend...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27488852/an-evaluation-of-the-current-patterns-and-practices-of-educational-supervision-in-postgraduate-medical-education-in-the-uk
#14
Priyank Patel
INTRODUCTION: Globally, clinical supervision has been widely adopted and studied. But in the UK, another variant of supervision has developed in the form of educational supervision. The quality of supervision remains highly variable and inadequate time, investment and guidance hinders its ability to actually benefit trainees. Therefore, undertaking a detailed study of the patterns and practices in educational supervision to inform developments in supervisory practice would be extremely beneficial...
August 2016: Perspectives on Medical Education
https://www.readbyqxmd.com/read/27441305/tracking-the-take-using-patient-flow-data-to-improve-amu-performance-and-safety
#15
L Powter, T Brougham, C Gillett
AIMS: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimise working patterns to improve waiting times. METHOD: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns...
2016: Acute Medicine
https://www.readbyqxmd.com/read/27435724/stress-and-wellbeing-of-junior-doctors-in-australia-a-comparison-with-american-doctors-and-population-norms
#16
COMPARATIVE STUDY
Deanne S Soares, Lewis Chan
BACKGROUND: Stress in doctors adversely affects decision-making, memory, information-recall and attention, thereby negatively impacting upon the provision of safe and high quality patient care. As such, stress in doctors has been subject to increasing scientific scrutiny and has amassed greater public awareness in recent years. The aims of this study are to describe stress levels and the psychological wellbeing of current junior medical officers (JMOs), and to compare this to their predecessors, American surgical residents and population norms...
July 19, 2016: BMC Medical Education
https://www.readbyqxmd.com/read/27418964/the-use-of-a-pro-forma-to-improve-quality-in-clerking-vascular-surgery-patients
#17
Jonathan Kentley, Amy Fox, Sophia Taylor, Yahya Hassan, Alicja Filipek
At our institution, a large tertiary referral centre for vascular surgery, patients are often admitted directly to the ward and clerked by foundation year one (FY1) doctors. We found that these clerkings frequently fell short of national record keeping standards, potentially leading to an increased risk for patients during their hospital stay. In addition, we found that junior doctors did not feel confident in clerking vascular surgery patients. A literature review found that high quality clerkings were strongly linked to improved patient safety, and that the use of a pro forma was one method to improve compliance with documentation guidelines...
2016: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/27281816/cardiac-arrest-leadership-in-need-of-resuscitation
#18
Philip S Robinson, Emma Shall, Roby Rakhit
BACKGROUND: Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. AIMS: To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. METHODS: Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds...
December 2016: Postgraduate Medical Journal
https://www.readbyqxmd.com/read/27256777/an-improvement-model-to-optimise-hospital-interdisciplinary-learning
#19
Deborah A McNamara, Paul Rafferty, Fidelma Fitzpatrick
Purpose - Interdisciplinary healthcare education and collaboration facilitates healthcare quality improvement (QI). Education challenges include cost, logistics and defining the optimum staff-engaging method. The purpose of this paper is to determine the optimum QI educational model and measure its impact using plan-do-study-act (PDSA) cycles. Design/methodology/approach - The authors established an on-site interdisciplinary QI learning collaborative: weekly 30-minute learning sessions close to the working environment; a learning materials Twitter repository; and junior doctor-led QI work streams aligned with surgical directorate quality goals supported by a mentorship network...
June 13, 2016: International Journal of Health Care Quality Assurance
https://www.readbyqxmd.com/read/27239308/improving-analgesia-in-fractured-neck-of-femur-with-a-standardised-fascia-iliaca-block-protocol
#20
Paul Watson, Szabolcs Rugonfalvi-Kiss
Fractured neck of femur (NOF) causes significant morbidity and pain for patients; adequate analgesia is an essential component of patient centred care. Patients experiencing greater pain during treatment for fractured NOF are slower to mobilise and have poorer health-related quality of life. NICE guidance suggests considering adding nerve blocks if paracetamol and opioids do not provide sufficient preoperative pain relief. We set out to audit pain levels in this group of patients in a small District General Hospital and to develop a protocol to improve analgesia provision if required...
2016: BMJ Quality Improvement Reports
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