1. Night Time Emergency Department Secondment: An Alternative to Extended Junior Doctor Surgical Cross-Cover in ENT and Beyond? Williams R 1, Hope A 2 1 Institute of Naval Medicine, Gosport, UK. 2 MDHU Derriford, Plymouth, UK. Richard.williams8@nhs.net Background With declining working hours, ever-tighter budgeting and reduced trainee numbers, innovative solutions were required to maintain a specialist knowledge base for ENT care at night. The literature warns of the dangers of increasing surgical cross- cover, resulting in junior doctors covering specialties with inadequate training, working outside their sphere of interest. Background With declining working hours, ever-tighter budgeting and reduced trainee numbers, innovative solutions were required to maintain a specialist knowledge base for ENT care at night. The literature warns of the dangers of increasing surgical cross- cover, resulting in junior doctors covering specialties with inadequate training, working outside their sphere of interest. The Problem - Derriford Hospital is a 900-bed tertiary referral center serving a population of 450,000. - Plastic and ENT Surgery junior doctors cross-cover at night - Aug 2011 saw an enforced reduction in junior doctors from 12 to 10 The Problem - Derriford Hospital is a 900-bed tertiary referral center serving a population of 450,000. - Plastic and ENT Surgery junior doctors cross-cover at night - Aug 2011 saw an enforced reduction in junior doctors from 12 to 10 Management Solutions - Increase inter-departmental cross-cover thus diluting the knowledge base of the covering junior doctor - Increase compensatory leave allowing increased frequency of night shifts, which would reduce junior doctor training experience Management Solutions - Increase inter-departmental cross-cover thus diluting the knowledge base of the covering junior doctor - Increase compensatory leave allowing increased frequency of night shifts, which would reduce junior doctor training experience Cycle 1 An audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Hospital at night ward tasks completed - Audit of Emergency Department (ED) consultations and compliance with current Clinical Quality Indicators (CQIs) Cycle 1 An audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Hospital at night ward tasks completed - Audit of Emergency Department (ED) consultations and compliance with current Clinical Quality Indicators (CQIs) Cycle 1 Conclusions - ENT/Plastics Surgery junior doctor were underemployed at night - Poor CGIs for ENT/Plastics patients - Large duplication of work with ED and ENT/plastics dual clerking patients - 64% ward tasked were generic - 68% ward tasks were routine Cycle 1 Conclusions - ENT/Plastics Surgery junior doctor were underemployed at night - Poor CGIs for ENT/Plastics patients - Large duplication of work with ED and ENT/plastics dual clerking patients - 64% ward tasked were generic - 68% ward tasks were routine Job Description - Based in ED minors 2100-0700 - See and treat all potential ENT and plastic surgical cases upon presentation - To be re-called for ward tasks according to priority category - To work within a structured system of ED clinical supervision for patients not formally followed up by ENT/plastic surgery services. Job Description - Based in ED minors 2100-0700 - See and treat all potential ENT and plastic surgical cases upon presentation - To be re-called for ward tasks according to priority category - To work within a structured system of ED clinical supervision for patients not formally followed up by ENT/plastic surgery services. Further Development - Extension of service framework to other specialties (e.g. orthopedics and psychiatry) and other hospitals. - The establishment of a hospital wide service to deal with generic ward tasks without recalling seconded juniors from ED. - Hospital systems to reduce the amount of routine ward tasks performed at night Further Development - Extension of service framework to other specialties (e.g. orthopedics and psychiatry) and other hospitals. - The establishment of a hospital wide service to deal with generic ward tasks without recalling seconded juniors from ED. - Hospital systems to reduce the amount of routine ward tasks performed at night Conclusions PTs received more expedient care PTs seen by more complaint specific clinician ENT maintained a specialist junior doctor service without increased cross-cover ENT reduced junior doctor salary expense with ED funding banding change ED secured improved CQIs ED staff freed of the burden of dual clerking JUNIORs increased training exposure by 26% JUNIORS received increased salary banding Conclusions PTs received more expedient care PTs seen by more complaint specific clinician ENT maintained a specialist junior doctor service without increased cross-cover ENT reduced junior doctor salary expense with ED funding banding change ED secured improved CQIs ED staff freed of the burden of dual clerking JUNIORs increased training exposure by 26% JUNIORS received increased salary banding Cycle 2 A re-audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - Analysis of impact on exposure to training. Cycle 2 A re-audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - Analysis of impact on exposure to training. Cycle 3 Further re audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - To assess lasting effect of service Cycle 3 Further re audit of ENT/Plastic Surgery junior doctor activity at night - 6/52 prospective data - Audit of Emergency Department patients seen and compliance with current Clinical Quality Indicators - To assess lasting effect of service INTERVENTION THE SECONDMENT OF THE NIGHT ENT/PLASTICS SURGERY JUNIOR DOCTOR TO THE ED AS THEIR PRIMARY PLACE OF WORK INTERVENTION THE SECONDMENT OF THE NIGHT ENT/PLASTICS SURGERY JUNIOR DOCTOR TO THE ED AS THEIR PRIMARY PLACE OF WORK