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Improving compliance with requirements on junior doctors' hours.

ABSTRACT: Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed.Audit of change.Paediatric night rota in large children's hospital.Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through critical incident reports.Development of new staff roles, followed by change from a partial shift rota comprising 11 doctors and one senior nurse, to a full shift night team comprising three middle grade doctors and two senior nurses.Compliance with regulations on working hours increased from 33% to 77%. Workload changed little and was well within the capacity of the new night team. The effect on patient care and on medical staff requires further evaluation.Reduction of junior doctors' working hours requires changes to roles, processes, and practices throughout the organisation.

SUBMITTER: Cass HD

PROVIDER: S-EPMC1126659 | biostudies-literature | 2003 Aug

REPOSITORIES: biostudies-literature

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Improving compliance with requirements on junior doctors' hours.

Cass Hilary D HD Smith Isabel I Unthank Cheryl C Starling Colin C Collins Jane E JE

BMJ (Clinical research ed.) 20030801 7409

<h4>Problem</h4>Compliance with UK regulations on junior doctors' working hours cannot be achieved by manipulating rotas that maintain existing tiers of cover and work practices. More radical solutions are needed.<h4>Design</h4>Audit of change.<h4>Setting</h4>Paediatric night rota in large children's hospital.<h4>Key measures for improvement</h4>Compliance with regulations on working hours assessed by diary cards; workload assessed by staff attendance on wards; patient safety assessed through cr ...[more]

PMID: 12896942

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Project description:ObjectiveTo explore the effects of the UK Working Time Regulations (WTR) on trainee doctors' experience of fatigue.DesignQualitative study involving focus groups and telephone interviews, conducted in Spring 2012 with doctors purposively selected from Foundation and specialty training. Final compliance with a 48 h/week limit had been required for trainee doctors since August 2009. Framework analysis of data.Setting9 deaneries in all four UK nations; secondary care.Participants82 doctors: 53 Foundation trainees and 29 specialty trainees. 36 participants were male and 46 female. Specialty trainees were from a wide range of medical and surgical specialties, and psychiatry.ResultsImplementation of the WTR, while acknowledged as an improvement to the earlier situation of prolonged excessive hours, has not wholly overcome experience of long working hours and fatigue. Fatigue did not only arise from the hours that were scheduled, but also from an unpredictable mixture of shifts, work intensity (which often resulted in educational tasks being taken home) and inadequate rest. Fatigue was also caused by trainees working beyond their scheduled hours, for reasons such as task completion, accessing additional educational opportunities beyond scheduled hours and staffing shortages. There were also organisational, professional and cultural drivers, such as a sense of responsibility to patients and colleagues and the expectations of seniors. Fatigue was perceived to affect efficiency of skills and judgement, mood and learning capacity.ConclusionsLong-term risks of continued stress and fatigue, for doctors and for the effective delivery of a healthcare service, should not be ignored. Current monitoring processes do not reflect doctors' true working patterns. The effectiveness of the WTR cannot be considered in isolation from the culture and context of the workplace. On-going attention needs to be paid to broader cultural issues, including the relationship between trainees and seniors.

Project description:BackgroundFirst-year doctors found that during out-of-hours shifts they were being delayed and distracted from reviewing potentially sick/deteriorating patients by a high volume of prescribing tasks. This predominately consisted of oral anticoagulation prescribing and rewrites of drug charts. We hoped that if we could reduce this burden of "inappropriate prescribing tasks", we could not only improve junior doctors' job satisfaction and opportunities for training but also give them more time for patient reviews.MethodsThree weekends were initially audited to quantify the number of "inappropriate prescribing tasks" using data from the hospital's computerized task assigning system. On three subsequent weekends, a checklist was handed out to the ward teams on Friday mornings. This checklist was designed to encourage the day teams to check that drug charts would not need oral anticoagulation or rewriting over the weekend.ResultsAn overall reduction in "inappropriate prescribing tasks" of 46% with a specific reduction in inappropriate oral anticoagulation prescribing of 65% was observed. Inappropriate drug chart rewrites were reduced by 30%. The reduction in the mean number of pre-intervention inappropriate prescribing tasks (as a percentage of total prescribing tasks) and the post-intervention mean was 6.94% (95% confidence interval -0.54 to 14.42, p-value=0.062).ConclusionImproved job satisfaction and a perceived reduced workload were noted from post-intervention qualitative surveys. While improved patient safety directly resulting from this intervention is more difficult to establish, and the observed reduction in inappropriate prescribing was only approaching statistical significance, our colleagues commented in post-intervention feedback that they felt they had more time, and felt less pressured, while attending patients. The workload of junior doctors can exert a significant effect on patient care, and simple measures can alleviate this burden. Furthermore, computerized hospital task management systems are an underutilized source of data for audit and quality improvement.

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Improving compliance with requirements on junior doctors' hours.

Publications

Improving compliance with requirements on junior doctors' hours.

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