Junior doctor confidence, and competence, in wound care management in the emergency department

Dr EBeck

Introduction

Wound management is an essential part of emergency medicine practice. Clinicians careforwounds ranging fromminor and simple lacerations or abrasions, to complex wounds (1). Approximately 4 million patients with a wound, are managed by the NHS per year. The annual cost of wound management in theNHSequates to £8.3 billion (2). During myemergency medicinejob, I noticed that, despite the high prevalence in presentation and cost to the NHS; junior doctors were not confident in woundcare. This was particularly apparent out of hours when staffing levels are lower, and seniors are often busy and unable to help.

Aims

1. To establish whether junior doctors felt confident in their ability to manage wounds in the Emergency Department

2. To establish if junior doctors were competent in wound care does their knowledge of woundcaremeet hospital guidelines?

3. To establish if junior doctors had access to quality resources they could use for help with wound management

4. To identify common knowledge gaps that can be targeted when creating future educational resources and training programs

Methodology

Cohort study of junior doctors (F2 to middle grade, n = 22) working in different emergency departments in the UK (predominantly Worthing hospital).

Confidence in wound care management was assessed using a self assessment questionnaire where participants would gradehow confident they felt in different wound care scenarios.

Competence was evaluated using a series of single best answer questions (based on hospital and best practice guidelines) common scenarios that can present in wound care in the emergency department: dressing types and suitability, basic suturing techniques, risk factors for delayed healing and criteria for referral to a specialist plastic surgery centre etc. Answersfromallparticipantswere then combined to identify common knowledge gaps that can be targeted.

Participant's self-assessed confidence in different aspects of wound care Confident Unconfident

"Medical school adequately prepared me for wound care management"

Competence in wound care as per SBA score

Results

Only 20% of participants felt confident in wound care overall in the emergency department.

Participants felt least confident in knowing when a patient needed referral to plastic surgery (15%), and most confident in applying interrupted sutures to a wound (90%).

Only 5% felt medical school had adequately prepared them for wound care management.

Score greater than 50% Score of 50% or less Strongly agree

Only 33% scored higher than 50% in the competence SBA assessment. The lowestscore in the SBA was 0%, the highest was 75% The average score was 42%.

Know where to find help with wound care when seniors are busy

"A concise intranet resource for wound care management, that we could refer to out of hours, WOULD be useful" Very confident

Conclusions and lessons learnt

1. Junior doctors are neither confident nor competent in wound care

2. Medical schools currently do not adequately train medical students in wound care

3. There are notsufficient online resources to provide accurate wound care guidance

4. Juniordoctors are not sufficiently supportedout of hours in wound care management

Have a reliable online resource they can refer to for help with wound care management

Only 40% were able to correctly list 3 woundcriteria that would mean a referral to plastic surgery should be made

Only 5% wereable to correctly identify iodine wash should be used with cation

63% wereable to correctlyidentify ONE dressing that should be used on a wound type (bleeding wounds). Only 18% were able to correctly matchall dressings towound type

>60% of participants said it took between 1-2 hours to receive a plan from the local plastic surgery centre once the referral had been made.

Only 32% felt they knew where to find help with wound care if seniors were busy or it was out of hours.

Only 4.5% felt they had a reliable online resource they could refer to for help with wound care.

73% felt a concise intranet resource to help with wound care would be useful

5. Junior doctors can correctly identify areas in wound care where their knowledge is lacking

6. Better education in woundcare is needed

7. Waiting for specialist advice from plastic surgery is excessively time consuming

Yes No

Next steps

Iam working withWorthing hospital A+Econsultants and advanced nurse practioners (ANPs) to create a concise, evidence based, online guide ; that junior doctors can refer to for help with wound care. This aims to be a comprehensive guide, but with special focus on the knowledge areas that were identified in this study to be lacking e.gplastic surgery referralcriteria.

In thefuture wehopeto design a complete wound care course that junior doctors will complete during their A+E rotations. This will include a series of teaching sessions from senior doctors and ANPs. On successful completion of the course junior doctors will be provided with a certificate.