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Retrospective analysis of the national impact of industrial action by English junior doctors in 2016.

ABSTRACT: OBJECTIVES:To examine the impacts of the four episodes of industrial action by English junior doctors in early 2016. DESIGN:Descriptive retrospective study of admitted patient care, accident and emergency (A&E) and outpatient activity in English hospitals. SETTING:All hospitals across England. PARTICIPANTS:All patients who attended A&E or outpatient appointments or those who were admitted to hospital during the 3-week period surrounding each of the four strikes (12 January, 10 February, 9-10 March and 26-27 April, excluding weekends). MAIN OUTCOME MEASURES:Raw numbers and percentage changes of outpatient appointments and cancellations, A&E visits, admitted patients and all inhospital mortality on strike days compared with patient activity on the same weekday in the weeks before and after the strikes. RESULTS:There were 3.4?million admissions, 27?million outpatient appointments and 3.4?million A&E attendances over the four 3-week periods analysed. Across the four strikes, there were 31?651 fewer admissions (-9.1%), 23?895 fewer A&E attendances (-6.8%) and 173?462 fewer outpatient appointments (-6.0%) than expected. Additionally, 101?109 more outpatient appointments were cancelled by hospitals than expected (+52%). The 26-27 April strike, where emergency services were also affected, showed the largest impacts on regular service. Mortality did not measurably increase on strike days. Regional analysis showed that services in the Yorkshire and the Humber region were disproportionately more affected by the industrial action. CONCLUSIONS:Industrial action by junior doctors during early 2016 caused a significant impact on the provision of healthcare provided by English hospitals. We also observed regional variations in how these strikes affected providers.

SUBMITTER: Furnivall D

PROVIDER: S-EPMC5855458 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Retrospective analysis of the national impact of industrial action by English junior doctors in 2016.

Furnivall Daniel D Bottle Alex A Aylin Paul P

BMJ open 20180208 1

<h4>Objectives</h4>To examine the impacts of the four episodes of industrial action by English junior doctors in early 2016.<h4>Design</h4>Descriptive retrospective study of admitted patient care, accident and emergency (A&E) and outpatient activity in English hospitals.<h4>Setting</h4>All hospitals across England.<h4>Participants</h4>All patients who attended A&E or outpatient appointments or those who were admitted to hospital during the 3-week period surrounding each of the four strikes (12 J ...[more]

PMID: 29438959

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Project description:ObjectivesTo investigate whether further centralisation of acute stroke services in Greater Manchester in 2015 was associated with changes in outcomes and whether the effects of centralisation of acute stroke services in London in 2010 were sustained.DesignRetrospective analyses of patient level data from the Hospital Episode Statistics (HES) database linked to mortality data from the Office for National Statistics, and the Sentinel Stroke National Audit Programme (SSNAP).SettingAcute stroke services in Greater Manchester and London, England.Participants509?182 stroke patients in HES living in urban areas admitted between January 2008 and March 2016; 218?120 stroke patients in SSNAP between April 2013 and March 2016.InterventionsHub and spoke models for acute stroke care.Main outcome measuresMortality at 90 days after hospital admission; length of acute hospital stay; treatment in a hyperacute stroke unit; 19 evidence based clinical interventions.ResultsIn Greater Manchester, borderline evidence suggested that risk adjusted mortality at 90 days declined overall; a significant decline in mortality was seen among patients treated at a hyperacute stroke unit (difference-in-differences -1.8% (95% confidence interval -3.4 to -0.2)), indicating 69 fewer deaths per year. A significant decline was seen in risk adjusted length of acute hospital stay overall (-1.5 (-2.5 to -0.4) days; P<0.01), indicating 6750 fewer bed days a year. The number of patients treated in a hyperacute stroke unit increased from 39% in 2010-12 to 86% in 2015/16. In London, the 90 day mortality rate was sustained (P>0.05), length of hospital stay declined (P<0.01), and more than 90% of patients were treated in a hyperacute stroke unit. Achievement of evidence based clinical interventions generally remained constant or improved in both areas.ConclusionsCentralised models of acute stroke care, in which all stroke patients receive hyperacute care, can reduce mortality and length of acute hospital stay and improve provision of evidence based clinical interventions. Effects can be sustained over time.

Project description:ContextThe transition from medical student to junior doctor is challenging. Junior doctors need to become part of the physician community of practice (CoP), while dealing with new responsibilities, tasks and expectations. At the same time, they need to learn how to navigate the frontiers and intersections with the other communities of practice that form the Landscape of Practice (LoP). This study aims to understand how junior doctors experience interprofessional collaboration (IPC) and what elements shape these experiences considering their transition to clinical practice.MethodsIn this multicentre qualitative study, 13 junior doctors individually drew two rich pictures of IPC experiences, one positive and one negative. A rich picture is a visual representation, a drawing of a particular situation intended to capture the complex and non-verbal elements of an experience. We used semi-structured interviews to deepen the understanding of junior doctors' depicted IPC experiences. We analysed both visual materials and interview transcripts iteratively, for which we adopted an inductive constructivist thematic analysis.ResultsWhile transitioning into a doctor, junior doctors become foremost members of the physician CoP and shape their professional identity based on perceived values in their physician community. Interprofessional learning occurs implicitly, without input from the interprofessional team. As a result, junior doctors struggle to bridge the gap between themselves and the interprofessional team, preventing IPC learning from developing into an integrative process. This professional isolation leaves junior doctors wandering the landscape of practice without understanding roles, attitudes and expectations of others.ConclusionsLearning IPC needs to become a collective endeavour and an explicit learning goal, based on multisource feedback to take advantage of the expertise already present in the LoP. Furthermore, junior doctors need a safe environment to embrace and reflect on the emotions aroused by interprofessional interactions, under the guidance of experienced facilitators.

Dataset Information

Retrospective analysis of the national impact of industrial action by English junior doctors in 2016.

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Retrospective analysis of the national impact of industrial action by English junior doctors in 2016.

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