Transcript Document

Better Training
Better Care
Hot and Cold Teams: Enhancing Trainee
Experience, Improving Patient Care
Dr Prathibha B.
Consultant Respiratory Physician and Director of Medical Education,
BTBC Project Executive
Susan Kennedy
Educationalist/BTBC Project Manager
Better Training Better Care
Aims to improve the quality of training and learning for the benefit of
patient care
Professor Sir John Temple: Time for Training
•
‘Making every moment count’
•
‘Appropriate supervision’ and/or ‘Consultant present service’
•
‘Service delivery must explicitly support training’
Professor John Collins: Foundation for Excellence
•
Appropriate supervision for trainees
•
Concerns that trainees are working beyond their level of competence
•
Redistribution of posts and community experience
www.hee.nhs.uk
www.hee.nhs.uk
East Kent Hospitals NHS Foundation Trust–
Hot and Cold Teams: Enhancing Trainee Experience, Improving Patient Care
Redesigned the service model in medicine in
order to:
1.
Improve patient care/safety out-of-hours
and at weekends
2.
Improve supervision/support for trainees
3.
Provide improved/increased educational
opportunities for trainees
Increased
number of
safe,
appropriate
discharges
at weekends
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Reduced
length of
stay for
patients at
weekends
Increased
attendance
at clinics by
training
doctors
Improved
handover
(Friday) and
support for/
supervision
of trainees
BTBC
F1/HST
CMT/F2/GPST
MONDAY TUESDAY WEDNESD THURSDAY FRIDAY
SAT
SUNDAY
MONDAY TUESDAY
WEDNESD THURSDAY FRIDAY
SAT
SUNDAY
WEEK 1
ON
ON
OFF/TR
OFF/TR
ON
ON
ON
WEEK 1
ON
ON
OFF/TR
OFF/TR
ON
ON
ON
WEEK 2
OFF
OFF/TR
ON
ON
OFF
OFF
OFF
WEEK 2
OFF
OFF/TR
ON
ON
OFF
OFF
OFF
WEEK 3
WEEK 3
ON(N)
ON(N)
OFF
OFF
ON(N)
ON(N)
ON(N)
WEEK 4
WEEK 4
OFF
OFF
ON(N)
ON(N)
OFF
OFF
OFF
WEEK5
WEEK5
WEEK 1
ON
ON
OFF/TR
OFF/TR
ON
ON
ON
WEEK 6
WEEK 2
OFF
OFF/TR
ON
ON
OFF
OFF
OFF
WEEK 7
WEEK 3
WEEK 8
WEEK 4
ON
WEEK5
ON
ON
WEEK 9
WEEK 10
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Better Training Better Care
New Weekend Hot and Cold Team Working in Medicine at WHH
HOT PATIENT
COLD PATIENT
(ACUTE ADMISSION)
(ON COLD WARDS btwn 9am-5pm)
DISCHARGE
HOT
HCOO
P
CONS
A&E
REFERRAL
GP
GP
OTHER
includin
g stroke
calls
AE
High
Dependency
CCU
REFERRAL
COLD
RESUS
ITU
Planned
reviews
Acute
reviews
EAU
MED
CON
S
HOT
SHO
Contacts
HOT
REG
CDU
Hot Reg – 8505
SHO1 – 8507
HOT
8505
REG
MED
8506
SHO
2
WACU
MED
CON
S
CM
Hot F1 – 8500
HOT
REG
Cold Reg – 8557
CJ
Cold Reg Mob
07920785894
OXFORD
HOT
F1
Advice/referrals
for/from other
specialties
CL
CLERKING
COL
D
REG
***********
HOT
SHO
SPR/ACUTE CONS REVIEW OF F1
AND UNWELL PATIENTS
07880786941
BOTH
CON
S
RST
Cold F1 8504
OUTLIERS
HOT
8500
F1
PTWR
08.30
COLD
8557
REG
SENIO
R
NURSE
COL
D F1
Senior Nurse Mob
HCOO
P 8507
SHO
1
SHO 2 – 8506
CK
HCOO
P
CONS
Revie
w
Patient
COL
D
8504
F1
SENIO
R
NURSE
SAT/SUN
HANDOVER
All Cardiac Arrest Calls IN ALL
AREAS
Covered by Hot Team, led by
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Hot Reg. Cold F1 not involved in any
Cardiac Arrests Calls.
HOT
F1/S
HO
1.
2.
3.
4.
Twilight handover for Hot Team/Night Team at 9.00pm
Morning handover for Night Reg to Cold Reg at 9.15am in CDU
Cold Team meeting at 1pm on CM1
Cold Reg handover to Hot Reg at 5pm
BTBC
Training Outcomes
Patient outcomes
1.Improved Handover
1.Reduction of length at
weekends.
2.Increased opportunities
for clinic attendance.
3.Improved supervision.
4.Improved opportunities
for practical procedures.
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2.Increase in weekend
discharges.
3. Reduction in weekend
mortality.
4. Reduction in SUIs involving
juniors at weekends.
Cold Team –Examples of Senior Nurse work
Verify RIP, EDN
Ref to Reg for reviewx3
INR reviews
3 discharges
Ref to Ref for reviewx5, PICC line Order CXR
Check trp, IV fluids, CTPAs
1 syringe driver set up, 4 discharges
Ultrasound Scan venous cannula,2 discharges, vanc
Dig Levels, Vanc.Levels
level
IV fluidss
Dig Levels, Vanc.Levels
Liaise with Radiology
D/w Microbiologist
1EOL
PGD prescription
Assist with leg plaster
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Reg
review
1verify RIP, 2 discharges
Vanc level
Chase CT results
CT reviewx2
PICC removal
Syringe driver
Verified RIPx2
abg, H@H
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www.hee.nhs.uk
05/07/14
www.hee.nhs.uk
www.hee.nhs.uk
05/07/14
East Kent Hospitals NHS Foundation Trust–
Hot and Cold Teams: Enhancing Trainee Experience, Improving Patient Care
Any pilot or new way of working can
present challenges. Our pilot presented
us with a number of challenges which we
were able to overcome
Resistance
to change
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Unfilled
posts within
the rota
Annual
leave and
the rota
Evidencing
improvement

Based on patient’s and trainees needs, skills needed and workforce
availability, teams were created in innovative ways by deploying appropriate
staff to improve patient care and training, in a cost-effective way.

Multi-professional project team, to problem solve and plan together for a
practical solution that would work in our own context

Through the creation of a weekend multi-professional (doctors, nurses,
HCAs, medical students and managers), ward-based, cold team, we have
helped move towards 7 day working.
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Further evidence
Trainees: Focussed learning in blocks; opportunities for leadership;
dedicated time in rota for educational activities.
Patients: Better organisation and more efficient weekend cover,
improved handover, higher expectation of levels of care by all.
Nurses / HCA: Able to provide additional support for training doctors at
weekends; greater empowerment at weekends to make a significant
difference to the patient experience and to work effectively as part of a
new enhanced, weekend team.
Medical students: Part of enhanced weekend team, seamless
transition into being a doctor in the new NHS.
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Questions
Dr Prathibha
Susan Kennedy
www.hee.nhs.uk
www.hee.nhs.uk