Quality improvement of information provision to Foundation Doctors in preparation for new rotations within Oxford University Hospitals NHS Foundation Trust

Background:

A high-quality induction is key for safe trainee changeover and maintained quality of patient care 1. We carried out a survey on 05/09/2022 and asked current Oxford University Hospitals (OUH) NHS Foundation Trust Foundation Doctors:

1. How well prepared did you feel for your latest OUH rotation?

2. How strongly do you agree that you were provided with enough information to be well prepared for your latest OUH rotation?

3. How useful did you find the information you were provided with before your latest OUH rotation?

4. How strongly do you agree that the information you were provided before your latest OUH rotation was role-specific?

Responses showed average scores of 5.4/10, 5.7/10, 6.2/10 and 6.8/10 respectively (N=36).

Aim:

To improve the quality of information provision to OUH Foundation Doctors in preparation for changeover to new rotations. We aimed to achieve this by August 2023 (end of the training year) with achievement of quality improvement indicated by increased scores out of 10 compared to baseline scores.

Methodology:

Intervention: FELS (Foundation Education Leads Group) OUH rotation fact-file

Induction booklets have been shown to have a positive effect on quality of junior doctor induction and patient safety 2,3 ,this was therefore considered an appropriate intervention.

The fact-file was designed based on what information current OUH Foundation Doctors said they wanted to know before a new OUH rotation (Template shown by Figure 1). It was then created using information from OUH rota coordinators and human resources teams, and current OUH Doctors.

Results:

PDSA (Plan-Do-Study-Act) Cycles:

Act: Further improvement of fact-file achieved

Study: Feedback form and repeat of initial survey

Baseline and repeat survey score results are shown in Figure 2

Plan: Design of OUH Rotation factfile Version 1

Do: Creation and release of Version 1

PDSA Cycle 1 - No improvement in score for any of the survey questions (N=10).

PDSA Cycle 2 – Improvement in score for all survey questions (N=5).

PDSA Cycle 3 - Further improvement (so far) for all survey questions (N=7).

Feedback:

How useful did you find the FELS OUH rotation Factfile?

Scores: Version 1: 8.4/10 Version 2: 9.2/10 Version 3: 9.2/10 (so far)

Learning Points:

• Foundation doctors felt better prepared for starting their new rotations having read the fact-file, with eased rotation changeovers

Limitations:

Act: Aim achieved but further factfile improvement possible

Study: Feedback form and repeat of initial survey

Plan: Design of OUH Rotation factfile Version 2

Do: Creation and release of Version 2

• Poor survey response rate from all current OUH Foundation Doctors limits the generalisability of our data

Conclusion:

Act: Further improvement of fact-file achieved

Study: Feedback form and repeat of initial survey

Plan: Design of OUH Rotation factfile Version 3

Do: Creation and release of Version 3

An OUH rotation fact-file can be used to improve the quality of information provision to OUH Foundation Doctors in preparation for new rotations

References:

1. Academy of Medical Royal Colleges, NHS Employers, 2013. Recommendations for safe trainee changeover.

2. Thomas N, McGrann E, Zammit L, et al. Junior doctor-designed induction booklet to improve future junior doctor experience in a new post. Future Healthc J 2019;6(Suppl 2):17. doi:10.7861/futurehosp.6-2s-s17

3. Ross D, Petrie C, Tully V. Introduction of a junior doctors' handbook: an essential guide for new doctors. BMJ Open Quality 2016;5:u209167.w3822. doi: 10.1136/bmjquality.u209167.w3822