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

East Kent Hospitals NHS Foundation Trust– Hot and Cold Teams: Enhancing Trainee Experience, Improving Patient Care Reduced length of stay for patients at weekends Increased attendance at clinics by training doctors Improved handover (Friday) and support for/ supervision of trainees Increased number of safe, appropriate discharges at weekends 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

BTBC F1/HST CMT/F2/GPST MONDAYTUESDAYWEDNESDTHURSDAYFRIDAYSATSUNDAY WEEK 1ON OFF/TR ON WEEK 2OFFOFF/TRON OFF WEEK 3ON(N) OFF ON(N) WEEK 4OFF ON(N) OFF WEEK5 WEEK 6 WEEK 7 WEEK 8 WEEK 9 WEEK 10 MONDAYTUESDAYWEDNESDTHURSDAYFRIDAYSATSUNDAY WEEK 1ON OFF/TR ON WEEK 2OFFOFF/TRON OFF WEEK 3 WEEK 4 WEEK5 WEEK 1ON OFF/TR ON WEEK 2OFFOFF/TRON OFF WEEK 3 WEEK 4 ON WEEK5

Better Training Better Care Contacts Hot Reg – 8505 SHO1 – 8507 SHO 2 – 8506 Hot F1 – 8500 *********** Cold Reg – 8557 Cold Reg Mob Senior Nurse Mob Cold F COLD PATIENT (ON COLD WARDS btwn 9am-5pm) A&E RESUS EAU CDU WACU REFERRAL Planned reviews Acute reviews Advice/referrals for/from other specialties CK CL CM CJ OXFORD RST OUTLIERS High Dependency CCU ITU All Cardiac Arrest Calls IN ALL AREAS Covered by Hot Team, led by Hot Reg. Cold F1 not involved in any Cardiac Arrests Calls. CLERKING SPR/ACUTE CONS REVIEW OF F1 AND UNWELL PATIENTS REFERRAL HOT PATIENT (ACUTE ADMISSION) GP AE OTHER includin g stroke calls 1.Twilight handover for Hot Team/Night Team at 9.00pm 2.Morning handover for Night Reg to Cold Reg at 9.15am in CDU 3.Cold Team meeting at 1pm on CM1 4.Cold Reg handover to Hot Reg at 5pm DISCHARGE Revie w Patient HANDOVER COLD HCOO P CONS SENIO R NURSE COL D 8504 F1 COLD 8557 REG MED CON S COL D REG COL D F1 SENIO R NURSE HOT HCOO P CONS MED CON S HOT 8505 REG MED 8506 SHO 2 HCOO P 8507 SHO 1 HOT 8500 F1 HOT REG HOT SHO HOT F1 HOT REG HOT SHO PTWR SAT/SUN HOT F1/S HO BOTH CON S New Weekend Hot and Cold Team Working in Medicine at WHH

BTBC Training Outcomes 1.Improved Handover 2.Increased opportunities for clinic attendance. 3.Improved supervision. 4.Improved opportunities for practical procedures. Patient outcomes 1.Reduction of length at weekends. 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, EDNINR reviews Ref to Reg for reviewx33 discharges Ref to Ref for reviewx5, PICC lineOrder CXR Check trp, IV fluids, CTPAs1 syringe driver set up, 4 discharges Dig Levels, Vanc.Levels Ultrasound Scan venous cannula,2 discharges, vanc level IV fluidss1verify RIP, 2 discharges Dig Levels, Vanc.LevelsVanc level Liaise with RadiologyChase CT results D/w MicrobiologistCT reviewx2 1EOLPICC removal PGD prescriptionSyringe driver Assist with leg plasterVerified RIPx2 Reg reviewabg,

05/07/14

05/07/14

East Kent Hospitals NHS Foundation Trust– Hot and Cold Teams: Enhancing Trainee Experience, Improving Patient Care Unfilled posts within the rota Annual leave and the rota Evidencing improvement Resistance to change 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

 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.

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. Further evidence

Questions Dr Prathibha Susan Kennedy