BPSC2022 Poster Group H - QI in Progress - Emergency and surgical care

18th May 2022 Poster Competition Group H QI in Progress Emergency and surgical care

Anaesthetic Consent: Information leaflets and patient recollection – could we be doing more?

Dr Beth Hancox and Dr Migara Seneviratne

Sherwood Forest Hospitals NHS Foundation Trust

The Problem • The Covid Pandemic has resulted in fewer elective patients physically attending pre-op clinic to discuss their anaesthetic options; low-risk patients are assessed over the phone.

• Conversations with patients highlighted many weren’t retaining key information on the risks and benefits of their anaesthetic.

Discussion - Study & Act • The data was presented and discussed at the departmental QI meeting.

• This highlighted an issue with patient engagement with the process of anaesthetic consent, contributing to a lack of awareness of the risks.

• An information poster was designed and displayed in patient-facing areas with the help of Pre-Operative Clinic and Day Case Unit teams.

Aims • Establish the discrepancies between what patients were consented for and their recollection of this – were information leaflets helping?

• Improve patient engagement in the process of consent.

RCOA Standard “Those undergoing elective surgery should be provided with information before admission, preferably at pre-assessment or at the time of booking, but the duty remains on the anaesthetist to ensure that the information is understood.”

(2017)

Method – Plan & Do • A simple questionnaire was designed and 30 patients approached on the day of their elective surgery and asked to complete it.

• Information was gathered on whether they could recall the anaesthetic they were having, the risks and benefits of this and whether they had found the posted information leaflet useful (2022).

• A mix of quantitative and qualitative data was obtained, including information on the grade of anaesthetist gaining consent and the type of surgery being performed.

• This was undertaken over a 6 week period and the results charted and analysed.

Results RISKS RECALLED

2+ risks

30%

0 risks

43% Conclusions & Next steps 1-2 risks

•

27%

“Reading through the pro’s and con’s of anaesthetic options didn’t seem relevant to me as it’s not something I can control” “I’ll just go with what my anaesthetist tells me – they know best!”

INFORMATION LEAFLETS

22%

Didn’t read

• • • •

Although most patients recalled the type of anaesthetic they were receiving, many (43%) retained no risks of it whatsoever.

The majority of patients are reading their information leaflets but many don’t feel that the volume of information was relevant to them and that these decisions were in the hands of their anaesthetist.

This has highlighted an issue with patient engagement with anaesthetic consent and a lack of awareness of the risks.

It is hoped that the posters will engage patients and encourage them to take an active interest in their anaesthetic.

Potential for further data collection within anaesthesia, as well as involvement of the rest of surgical division in gauging patient engagement in consent.

Bibliography 1. AAGBI: Consent for anaesthesia 2017. 2017. doi:10.1111/anae.13762/full. https://www.aagbi.org/sites/default/files/AAGBI_Consent_for_anaesthesia_20 17_0.pdf.

2. Patient information leaflets and video resources | The Royal College of Anaesthetists. rcoaacuk. https://rcoa.ac.uk/patient-information/patientinformation-resources/patient-information-leaflets-video-resources.

78% Did read

With thanks to…

Dr Rebecca Barker and the Pre-operative and Day Case Unit teams at Sherwood Forest Hospital NHS Trust

Reducing Violence and Aggression: Joining the Dots Dr Natalie Fairhurst, Dr Mohsin F. Butt and Dr Natalia Barry* *North Middlesex University Hospital NHS Trust, Sterling Way, London, N18 1QX natalia.barry@nhs.net

Introduction and aims

Summary of Stage 1 of the Quality Improvement Project:

Half of all reported violent incidents in healthcare settings occur in the emergency department (ED) (1). The British Medical Association have reported that over 40% of doctors have seen physical violence or verbal abuse in the workplace (2), making this is an occupational hazard.

The anxiety and stress endured by patients and carers is typically compounded by long waiting lists, which can fuel hostile behaviours towards staff (3). Workplace violence can result in lack of confidence, anxiety, increased use of alcohol and post-traumatic stress disorder (4), which highlights the importance of reducing this threat in the ED. It was clear from our Datix system (the NHS system for reporting incidents) that staff were experiencing frequent episodes of violence and aggression from visitors to our emergency department, with likely underreporting of levels. As such, our primary objectives were as follows: (a) To assess the extent of violent and aggressive behaviours within the department over a 4week period (b) To remind colleagues of the importance of not accepting these behaviours as or an acceptable part of daily work (c) To implement changes to the patient experience with a view to reducing the incidence of aggression towards staff in our department

Data analysis revealed that the highest incidence of workplace violence in the emergency department occurred in the reception area A working group was established to develop interventions that would enhance the patient experience in the waiting room and reduce violent acts Interventions included: Information on current waiting time Artwork describing the triage process Providing information in multiple languages Structural adjustments to the main waiting area Information on levels of violence and aggression toward NHS workers

Click to add text

Figure 1: Safety cross data collection tool (2)

Figure 2: Graph identifying distribution of events in three main departmental areas

Methodology and PDSA cycles Workplace violence was defined as "any incident in which an employee is abused, threatened or assaulted in circumstances relating to their

(2).

Numerous safety crosses (Figure 1) were displayed around the three central areas of the department: (a) the reception (b) adults ED and (c) paediatric ED. All staff members in the emergency department were made aware of this visual data collection tool and were asked to record all incidents of violent behaviour. Staff were requested not to duplicate their entries on multiple safety crosses.

Data analysis (Figure 2) revealed that the highest number of workplace violence events occurred in the reception area, which allowed us to prioritise interventions that would reduce violent behaviour in this specific area.

To this end, a working group was established along with help from NHS Patient Experience Group (PEG) to identify factors that contributed to patient experience within the ED. The PEG, reception staff, nursing staff and a group of local sixth form students (London Academy of Excellence, Tottenham) helped design interventions (Figure 3) to reduce violent acts in the reception area.

What did we learn?

Factors contributing to aggressive behaviours and interventions

Violence and aggression towards staff is a common occurrence and incidents are drastically under-reported.

Language Barriers

Unclear Triaging Process

Waiting Times

Prevalent languages identified

Triage process described

Differing waiting times explained

The focus of work going forward should be to address the contributory factors but also to highlight that violence is an unacceptable part of the daily staff experience.

Our audit has exposed these issues and reinforced the need for solutions.

Primary interventions have been made including the use of posters/artwork in the main waiting area which clarify the ED procedure, alongside more generic additions (plants, water fountain, clocks and waiting time board).

Key information translated

Posters produced to relay information

Electronic waiting time board

Our work is currently in progress and shall be re-audited in 6 months after all interventions have been introduced.

Figure 3: Flowchart identifying factors with suggested interventions

REFERENCES (1) Carver M, Beard H. Managing violence and aggression in the emergency department. Emerg Nurse. 2021 Nov 2;29(6):32-39. doi: 10.7748/en.2021.e2094. Epub 2021 Aug 19. PMID: 34410049.

(2) BMA. Preventing and reducing violence towards staff [Internet]. The British Medical Association is the trade union and professional body for doctors in the UK. 2022 [cited 19 April 2022]. Available from: https://www.bma.org.uk/advice-andsupport/nhs-delivery-and-workforce/creating-a-healthy-workplace/preventing-and-reducing-violence-towards-staff (3) D'Ettorre G, Pellicani V, Mazzotta M, Vullo A. Preventing and managing workplace violence against healthcare workers in Emergency Departments. Acta Biomed. 2018 Feb 21;89(4-S):28-36. doi: 10.23750/abm.v89i4-S.7113. PMID: 29644987 (4) Sofield L, Salmond SW. Workplace violence. A focus on verbal abuse and intent to leave the organization. Orthop Nurs. 2003 Jul-Aug;22(4):274-83. doi: 10.1097/00006416-200307000-00008. PMID: 12961971.

Appropriate Junior Doctor Staffing Improves Patient Safety, Training and Doctor Wellbeing C Daly, A Stevenson, A Thorne, J Fallon

Musgrove Park Hospital, Somerset NHS Foundation Trust, TA15DA Background

-of-hours patient care is provided by a doctor not normally working or training in the specialty. It occurs widely across the NHS, particularly in surgical specialties, and has implications for both patient safety and doctor wellbeing. Due to increasing general medical workload in our Trust, a decision was made some 15 years ago to reallocate foundation doctors from Trauma & Orthopaedics (T&O) and Ear, Nose and Throat surgery (ENT) to out-of-hours medical ward cover. This left one core surgical trainee or equivalent providing emergency cross-cover for all surgical specialties, including General surgery, Urology, Vascular surgery, ENT, T&O and Spinal surgery, resulting in an overwhelming and often unsustainable workload. Compounded by the pressure of providing emergency cross-cover for multiple unfamiliar specialties this situation led to negative trainee surveys, GMC reports and numerous Immediate Safety Concerns (ISC) and Exception Reports.

Methodology

This project aimed to improve patient care and post-graduate training through optimising junior doctor staffing in both the medical and the surgical directorate.

Business cases were generated using data from GMC surveys, Exception Reports and recent ISCs, and presented to the Trust Board, highlighting the concerns and suggesting sustainable solutions. In essence, funding to hire a number of additional junior doctors would be required to create a new tier in the surgical out-of-hours rota. Recruitment of surgical clinical fellows would enable a split of T&O and Spinal surgery from the rest of the surgical out-of-hours workload. Recruitment of medical clinical fellows was also needed in order to repatriate foundation doctors back to their home specialties. The business cases were approved, and a new out-of-hours rota was created and implemented in August 2021.

Qualitative evidence was gathered by surveying affected junior doctors before and after the change to assess its impact on doctor well-being and training as well as perceived patient safety. Quantitative analysis of Exception Reports and ISCs submitted during this period was also used as evidence to demonstrate improvement.

Results

Figure 1: Workload and rest breaks

Figure 2: Job satisfaction

The survey results following the change were overwhelmingly positive, showing a significant improvement in workload and rest breaks (Figure 1) and continuity of care for patients. Job satisfaction improved, with 81% of surgical junior doctors reporting they would recommend their job, compared with only 42% prior to the change (Figure 2). Foundation doctors in T&O reported higher levels of confidence and enhanced learning due to more consistent exposure to the specialty (Figure 3). There have been fewer Exception Reports (Figure 4) and no ISCs raised outof-hours in surgery since July 2021, compared with eleven in the previous 18 months.

Lessons

We have learned that historic short-term fixes such as the reallocation of foundation doctors to provide service provision within other departments can have detrimental long-term effects. This improvement project has shown that the use of data to demonstrate longstanding problems can help advocate for funding and systemic change that improves the welfare of patients and doctors alike.

References

1. Wild, J.R.L., Lambert, G., Hornby, S. and Fitzgerald, J.E.F., 2013. Emergency cross-cover of surgical specialties: consensus recommendations by the Association of Surgeons in Training. International Journal of Surgery, 11(8), p584-588 2. Lineham, B., Jenny, B., Bateman, K. et al, royal College of Surgeons Edinburgh, 2020. Improving Patient Safety Out of Hours. Available from https://www.rcsed.ac.uk/media/682263/out-of-hours-doc.pdf 3. Health Education England. Cross Cover by Doctors in Training. Available from https://www.hee.nhs.uk/sites/default/files/documents/Cross%20cover%20by%20doctors%20in%20training%20policy%20update_0.pdf

Figure 3: Training for foundation doctors Exception Reports for Working Hours within the Surgical Directorate 25 20 15 10 5 0 Aug

Sept

Oct 2019

Nov

Aug

Sept

Oct 2021

Figure 4: Exception reports

Nov

Bolton NHS FT Critical Care Extubation Checklist.

Dr Jonathan Reid, Dr Lawrence Pugh, Dr Sarah Thornton.

Background: During the COVID-19 pandemic, there has been a significant increase in the number of mechanically ventilated patients across critical care units.

The 4th National Audit project of the Royal College of Anaesthetists (NAP4) found that over a quarter of the cases discussed involving major airway complications occurred at the end of anaesthesia or in recovery.

NAP 4 found that an unstructured approach to airway management complications led to poor outcomes.

The problem:

Aims:

The COVID pandemic presented challenges of high volumes of mechanically ventilated patients, as well as large numbers of redeployed staff of varied critical care experience.

We aim to provide a checklist to be used when extubating all intubated patients to help anticipate and prevent complications in patients on critical care.

This heightened the risk at extubation, and highlighted the need to optimise a structured approach to it.

We aim to aid staff members preparing for extubation, carrying out the procedure and looking after patients post-extubation..

Plan: Critical care MDT surveyed to evaluate confidence in being part of extubation team, and perceived benefit of a checklist.

Do: The checklist was initially designed by a team of medical and nursing staff.

Study: The Critical care MDT was then surveyed to evaluate the usage and merits of the checklist..

Act: The original checklist was re-designed based on the qualitive feedback and experience of using the checklist.

What we learnt

More than 1 in 5 critical care staff members did not feel confident being part of an extubation team All staff surveyed (n=22) stated that they thought that a checklist would be of at least some benefit, with 82% stating that they would find it very beneficial.

Based on feedback and experience, we created a one sided checklist uniform for all patients, guiding the MDT through preparation, the procedure, aftercare and complications.

Anticipated benefits

Throughout this project, we have experienced the challenges of a dynamic work environment with escalating volumes of mechanically ventilated patients and a high turnover staff with varying critical care experience.

We anticipate that this checklist will both improve the safety of extubation and confidence of staff members to participate safely in an extubation team.

We plan repeat cycles to evaluate the usage of the poster.

Future plans:

We are open to collaborating and sharing our findings with other critical care departments for the further development of this resource and further improvement of patient safety.

Do they need a top up?

A QIP to promote the consideration of blood transfusions for patients with a NOF #

Dr Catherine James Cardiff and Vale University Health Board, Wales, UK

BACKGROUND

AIM

Neck of femur (NOF) fractures are a common serious injury in older people & are associated with a high morbidity & mortality.

Wales Fragility Fracture Network suggest that patients who have undergone surgical repair for NOF fracture should have their post-operative haemoglobin (Hb) maintained above 90g/L, and above 100g/L for those with a history of ischaemic heart disease (IHD) 1. Therefore, the main aim of this study was:

Maintaining post-operative haemoglobin (Hb) aids mobility & rehabilitation, helping patients to return to their feet quicker.

Therefore, current practice at the University Hospital of Wales involves patients having day one post-operative bloods to consider their need for a blood transfusion.

To promote the consideration of blood transfusions for NOF # patients to optimise their post-op Hb

METHODS Data was collected retrospectively from the notes of general orthopaedic trauma patients who had sustained a NOF fracture during the period of 01/02/2022 – 28/02/2022.

Has your post-op NOF# patient had their day 1 Hb checked?

Data recorded included type of operation, if day one post-operative bloods were taken and whether there was any medical note about Hb/transfusion within 24 hours of operation.

The intervention was an information poster placed in the orthopaedic on-call room, theatre office and wards (01/03/2022) in addition to a WhatsApp message in the junior doctors group.

This quality improvement project was still in progress at the time of poster submission, with the second cycle being carried out from 01/04/2022 – 28/04/2022 to assess for any improvement following the intervention.

RESULTS

** Please ensure post-op bloods are documented + transfusions are considered **

DISCUSSION

1st Cycle: 25 patients, 100% had Day 1 post-op bloods taken.

However, 40% did not have them documented.

2nd Cycle: 18 patients, 89% had Day 1 post-op bloods taken.

Improvement, with 78% having bloods documented.

18% more patients being considered for transfusion.

Pre-intervention

40% of patients who underwent surgery following a NOF # fracture in February, had no day 1 post-op Hb documented in their notes

Post-intervention Documented Not documented

A simple intervention helped to improve the consideration of blood transfusion for 18% more NOF # patients.

However, 22% of patients, still did not have their Day 1 post-op bloods documented. Therefore, we cannot tell if these results were reviewed and whether the need for a blood transfusion was considered, based on their Hb. In addition, in the 2nd cycle 2 patients had no Day 1 post-op bloods taken at all.

Other interventions such as adjusting the NOF # proforma or a sticker in patient notes to prompt consideration for transfusion may help to further optimise patient's post-op Hb. 1. Wales Fragility Fracture Network. (2018). Post-operative haemoglobin guidelines.

Available at: https://www.networks.nhs.uk/nhs-networks/wales-frailty-fracture-network

Improving the diagnosis and treatment of UTIs in the emergency department Dr Tian Huang, Dr Rebecca Rodrigues, Dr Ziya Motala, Dr Thushanee Ramajayan, Dr Zoe Bleything

Introduction: From November 2019 - Jan 2020 Yeovil District Hospital prescribed the most UTI antibiotics in the South West A pharmacy review found a significant amount of the antibiotics were Pivmecillinam prescribed in ED TTO packs Possible causes included: 1. Patients with genuine UTIs attending ED instead of their GP for treatment due to lack of appointments 2. Patients being inappropriately prescribed antibiotics who did not have UTIs We decided to investigate to whether people were being prescribed UTI antibiotics according to trust and national guidelines.

Guidelines: Based on NICE quality statement 2015 (1) 1. Adults aged 65 years and over should have a full clinical assessment before a diagnosis of UTI is made 2. Healthcare professionals should not prescribe antibiotics to treat asymptomatic bacteriuria in adults with catheters and non-pregnant women 3. Healthcare professionals should not use dipstick testing to diagnose UTI in adults with urinary catheters Method: All urine dipstick tests done in yeovil ED between 01/05/2020 - 01/08/2020 were reviewed to establish: 1. What proportion were not indicated i.e. were performed on adults > 65 years old or adults with catheters?

2. Did these non-indicated dips lead to inappropriate antibiotic prescription in people with asymptomatic bacteriuria?

3. When antibiotics were prescribed did the antibiotic choice correspond to our trust guidelines?

4. When inappropriate urine dipsticks where performed, who requested them?

Unclear 3%

Initial results:

HCA 3%

Abx in asymptomadc catheterised padents 3%

Other e.g. no UTI symptoms 10%

Non-gudieline andbiodcs 11%

Abx in asymptomadc >65 years pts 8%

Over 65 AND catheterised 7%

ACP 3% Nurses 8%

Indicated 47% Over 65 years 29% Abx as per UTI gudieline 89%

No andbiodcs given 89%

Catheterised 6%

Proportion of indicated and not-indicated (with reason) urine dipsticks 01/05/20-01/08/20

Proportion of antibiotics prescribed due to inappropriate urine dipsticks

Proportion of antibiotics prescribed as per guidelines

Doctors 83%

HCP who requested inappropriate urine dipstick tests

Interventions • PDSA 1: Doctor focussed - poster in department, teaching for doctors, adding a UTI antibiotics indicating form to TTOs • PDSA 2: Nurse focussed - teaching for nurses • PDSA 3: Presentation at ED clinical governance meeting Did we improve?

12

Catheterised padents >65 years AND catheterised

>65 years Other

60

9 6

45

3

30

0 Pre-intervendon

15 0 Pre-intervendon Aeer PDSA 1

Aeer PDSA 2

Aeer PDSA 3

50 37.5

Percentage of andbiodc overtreatment

Percentage where non guideline andbiodcs where given

25 12.5 0 Pre intervendon Aeer PDSA 1

Aeer PDSA 2

Category Axis

Aeer PDSA 3

Aeer PDSA 1

Aeer PDSA 2

Aeer PDSA 3

Conclusions • Our interventions did not reduce inappropriate urine dipstick testing • Our interventions may have reduced off-guideline antibiotic prescriptions • Our interventions may have reduced overall antibiotic over treatment for UTIs

Have you seen the !-hcg?: Improving documentation of

emergency gynaecology clerking through implementation of a proforma L Samara, H Abdulgawad

Aims

Introduction At the Great Western Hospital, the on call team are responsible for clerking emergency gynaecology patients. This includes both junior doctors and advanced nurse practitioners with a wide spectrum of gynaecology experience. During post take ward rounds it was noted that areas of the gynaecology history, were not well documented. As well as areas of the examination, such as whether or not swabs were taken. Both of which delayed efficiency of ward rounds as repeat questioning was required.

Additionally, for early pregnancy patients, documentation of rhesus status and previous !-hcg results is vital for decisions on management. Accurate, clear and comprehensive clerking is essential to improve the quality of management plans and efficiency of subsequent reviews.

1. To improve clerking documentation, including gynaecology history, examination findings and results of investigations

2. To improve junior doctors’

confidence in gynaecology history taking

Method Initial survey of juniors PLAN

DO

Create proforma Introduction of proforma to department Extracts from the emergency gynaecology proforma

Teaching at induction Improvements to proforma

ACT

STUDY Repeat survey of juniors PDSA cycle

Results, Conclusions and Future Plans • The results demonstrated an improvement in documentation of history, examination and investigations as well as improved confidence amongst junior clinicians in clerking patients.

• The proforma also helped to prompt more senior reviews in complex patients prior to the consultant ward round.

• The use of a specific emergency gynaecology proforma improved the quality and consistency of clerking documentation.

Future plans: • Teaching on emergency gynaecology clerking at induction • Further improvements to the proforma based on feedback

Pre-proforma: How confident are you in taking emergency gynaecology histories?

0

I am more confident in taking histories in emergency gynaecology following introduction of the proforma

12.5

0

50

50

87.5

Extremely confident

Very confident

Somewhat confident

Not so confident

Not confident at all

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

Should pre-operative urine microscopy, culture & sensitivity prior to endoscopic Urological procedures be made mandatory: Results of a QIP at a Tertiary centre.

S. Theivendrampillai, F. New, B. K. Somani

University Hospital Southampton (UHS) NHS Foundation Trust, Southampton, United Kingdom

INTRODUCTION: Endourological procedures are minimally invasive surgeries used in Urology primarily to diagnose and treat urological diseases. It implies the use of special instruments which are introduced into the urinary system and allow antegrade access to the urinary tract.

For such procedures entering the urinary tract and breaching the mucosa, bacteriuria (BU) is a definite risk factor. Pre-operative urine microscopy, culture and sensitivity (MC&S) is recommended for all endourological procedures as per European Association of 1.

Urology (EAU) guidelines

AIM:

RESULTS:

PDSA Cycle 1

The quality improvement project was conducted to determine the rates of urine MC&S prior to endoscopic urological procedures and its relevance on post-operative urinary tract infectious complications.

It is important to diagnose and treat patients for urinary tract infections prior to to the endoscopic urological procedures to prevent serious adverse outcomes. The project was conceived to identify whether the Urology Department were keeping to the standards and to identify how patient safety and care could be improved.

Operation type

No. procedures

TURBT

PDSA Cycle 2

METHODOLOGY: Data was collected retrospectively of patients undergoing endourological procedures from November 2019 - March 2020.

We analysed the results of urine MC&S, and whether the results were acted upon, the endoscopic procedures undertaken, and outcomes related to infectious complications post-operatively.

30

MC&S sent at preassessment 2

Post-op infectious complications 7

Post-operative UTI with no MC&S sent 3

TURP

15

1

4

4

HoLEP

3

0

0

0

Cystoscopy URS

2 4

0 2

0 0

0 0

Operation type

No. procedures

TURBT TURP HoLEP URS

35 20 4 6

MC&S sent at preassessment 23 10 0 6

Post-op infectious complications 2 1 2 2

Post-operative UTI with no MC&S sent 1 1 2 0

Cycle 2

Cycle 1 9%

After analysing and presenting the data of the baseline first cycle at the local clinical governance meeting, recommendations were proposed to improve patient care, safety and outcome.

40%

60%

A second cycle was undertaken between June – September 2021 after changes were implemented.

91%

INTERVENTION: Recommendations “Every patient should have a urine MC&S prior to procedures as per guidelines to improve patient safety and care”

Actions taken • Departmental teaching session • Pre-assessment Team made aware of the updated policy • Urine MC&S requested for patients during their pre-assessment • Posters in pre-assessment clinic rooms • Pre-assessment Team to chase results and inform the on-call Urology team for positive MC&S results

MC&S No MC&S

MC&S No MC&S

Cycle 1: • 5/54 had urine MC&S prior to surgery • 11 (20%) patients developed post-operative urinary infection, 2 of which required admission for urosepsis.

Cycle 2: • Following the interventions, standards of care and safety improved significantly.

• 39/65 had urine MC&S sent at pre-assessment.

• 8/39 (20%) grew positive cultures and treated for prior to the surgery.

• 7 (10%) patients had infectious complications post-operatively.

Overall, there was a poor compliance of pre-operative MC&S for endoscopic procedures during the first cycle, potentially leading to avoidable adverse outcomes.

• Although not every patient had pre-op urine MSU, there was a marked improvement from 9% to 60%.

• There was an overall reduction in post-operative infection from 20% to 10%.

• Greater portion of patients were identified with positive urine cultures prior to their procedures.

• And thus, there is good evidence that pre-op urine MSU is required.

References; 1. Bonkat G, Pickard R, Bartoletti R, et al. EAU guidelines on urological infections. Eur Assoc Urol. 2017:22-26

Authors: Sameer Nagi, James Speed, Hannah Thomas, Sian Beasant, Peter Jackson, Dr Adam Hickson

Introduction Approximately 1.2 million NHS Hospital and Community Health Service Staff are in employment of whom 52.4% are professionally qualified clinical staff. Having collective interests among healthcare professionals (HCPs) has shown to improve teamwork leading to greater job satisfaction, improved healthcare outcomes and reduction in time of hospitalisation particularly in surgical teams.

Aim To evaluate the use of a publication of articles written by different HCPs related to surgery in understanding other

Methodology & PDSA cycles

Results

This was a single centre, longitudinal study.

Plan: Collate a peer-reviewed series of articles by different HCPs each month.

Upload online to intranet alongside a feedback survey.

2nd Ed(P)=0.006

3rd Ed(P)=0.001

Do: Dissemination of online feedback surveys, quantitative and qualitative feedback for each edition collected.

Study: Surveys used a 5-point Likert scale with a confidence interval of 95% one tailed test. Mean and standard deviations were calculated for improvement in knowledge, insight and interest in other HCP roles. Values st for the 1 publication were used as a nd baseline, the 2 publication results were compared with that of the first to generate p rd values. The 3 publication results were nd compared with the 2 edition to calculate p values. Improvement points and comments suggested by readers were noted.

2nd Ed(P)=0.02

3rd Ed(P)=0.109

Act: Coupling both the qualitative with quantitative results, suggested changes would be introduced for the subsequent nd edition e.g. for the 2 edition. The PDSA cycle would then be continued for each subsequent publication.

Conclusion Circulation of the surgical gazette can increase knowledge, insight and interest into other HCP roles. These are known factors that can improve teamwork.

Reflection Was able to involve different HCPs for a common goal. Learnt the difficulty of trying to quantify qualitative changes. If I was to repeat this, I would look to control more variables with the use of big data & consider a pre-survey.

2nd Ed(P)=0.029

P=statistically significant

3rd Ed(P)=0.131

P=not statistically significant