Context Night shifts in our district general hospital are staffed by a single ST4-8 trainee or staff grade registrar supported by 2 junior trainees. The junior trainee may be a ST1-3 in paediatrics, a GPVTS or an FY2 Trainee.
Problem Concerns were raised that having 2 GPVTS or FY trainees working at night could adversely affect patient safety.
Assessment of problem and analysis of its causes Concerns were raised that having 2 GPVTS or FY trainees put increased strain on the registrar covering the night shift. GPVTS and FY2 trainees also felt less supported during their night shifts when not paired with an ST1-3 trainee. As a result of this we trailed a rota that enabled GPVTS or FY2 trainees to always be paired with an ST1-3 when on nights.
Intervention To investigate whether a change in rota structure can lead to a perceived improvement to patient care and junior doctor supervision during night shifts.
Study design A new rota was designed and implemented over a 2 month period. Trainees were then asked to complete an anonymous survey comparing the 2 months of shifts with the new rota to the 2 months prior to rota being introduced.
Strategy for change A change in construction of the rota allowed a paediatric ST1-3 trainees to be paired with a GPVTS or FY2 trainee on night shifts
Measurement of improvement Trainees on the SHO and SpR rota were then asked to complete and anonymous survey to assess if there was any noticeable improvement.
Effects of changes We sent out the surveys to all of the 24 junior doctors employed on the SHO or SpR on-call rota. We received 20 responses, giving a 83% response rate. Of those responding 85% felt that patient safety was either somewhat or much improved following implementation of the new rota. 60% of respondents felt there was improved support on nights (Figure 1).
Lessons learnt Constructing a rota that allows for pairing of paediatric trained and non-paediatric trained staff leads to perceived improvements in patient safety and supervision of junior trainees
Message for others Balanced skill mix on night shifts contributes to patient safety, junior supervision and staff satisfaction.
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