Management station Flashcards
In the medical team what is the appropriate levels of escalation?
registrar - consultant - head of department - clinical director - medical director
What framework can be used to tackle questions regarding difficult colleagues i.e. drunk consultant
Ensure patient safety, is always your first priority
* Maintain professionalism by taking the situation away from patients,
* Offer your colleague support
* Find out more and discuss the situation, the initiative and act to resolve it if possible
* If resolution is not possible, then you need to escalate the situation to an appropriate level and
discuss with the MDU.
What is clinical audit?
“A systematic cyclical review of a practice or process to establish how well it meets and maintains predetermined standards.
What is quality Improvement?
a systematic cyclical process involving defining a clinical problem, planning, testing and analysing a change to bring about measurable improvement within healthcare
Planning
Defined the problem which was the need for transfer of patients between distant hospital sites for preoperative hand assessments for simple hand injuries.
The aim was to trial a novel teleconferencing system using augmented reality (AR) to remotely assess referrals and compare outcomes in terms of transfer cost and patient satisfaction compared to those transferred for face-to-face assessments.
Do: trialled intervention with a small number of cases compared to those managed in a conventional way by patient transfers for a separate clinic appointment.
Study: analysis of data demonstrated the safety and efficiency of teleconferencing virtual clinics reducing the need for transfer to the trauma clinic with the patient able to attend on the day of surgery.
Reduced steps in the treatment pathway with overall cost savings.
Act: the next phase involved applying for funding (£30,000) for the phased implementation of the scheme which will potentially reshape the pathway. With a further QI cycle in the planning phase.
Action: I recently presented the outcomes at a national conference, and there are plans to trial a multicentre study to review the effectiveness on a larger scale.
Are audits successful (and QI)?
A 2012 Cochrane review of 140 studies reported that audits lead to small but important improvements in clinical outcomes, but the key factor was how the feedback was delivered to effectively implement change (1).”
OR Clinical audits are a key pillar in clinical governance and have been shown to be successful on a local trust level and in large national audits,
Examples of audit done at Chelsea and westminster for the craniofacial plastics team
Why is audit / quality improvement important in surgery?
The GMC Good Medical Practice/ Royal College of Surgeons Good Surgical Practice recommend that all doctors should take part in regular audits or quality improvement practice.
Audits are important to patients, organisations and surgeons
Patients: ensure a high standard of care is met.
NHS/ organisation: a key pillar of clinical governance, compliance with guidelines, improves safety locally and nationally, improves teamwork and collaboration.
Surgeons: undertaking clinical audits have been useful from a personal perspective in surgery, clinically, academically, and in management.
Clinical perspective: learned about national standards on conditions for example hand fractures, as well as the local epidemiology.
Academic: experience in dealing with large data sets and statistics, as well as presenting results at conferences.
Management: leading colleagues and meeting different members of the NHS MDT to bring about change.
What is clinical Governance
a quality improvement framework through which the NHS aims to maintain and improve services whilst maintaining openness and accountability to the public
Clinical effectiveness and research: I have been involved in a variety of clinical research ranging from case reports to a randomised controlled trial I recently co-authored. I also read journals and am a member of the surgical journal club to keep up to date with the latest innovations in surgery.
Audit – I have undertaken a clinical audit for every job I have held. The audit I was most proud of… e.g. helped obtain funding for an additional clinic to ensure adherence to national guidelines on waiting times.
Education and training – Involved as a teacher and trainee
As a teacher: I have a passion for teaching and have recently completed a PgCert in clinical education. This has helped me to set up a regional anatomy course and helped to organise the medical student teaching in my hospital.
Trainee perspective, I undertake regular meetings with my education supervisor, complete WBAs with trainers, undertake a personal development plan and reflective practice, and attend teaching courses most recently… e.g. microsurgical course’.
Other pillars of governance examples:
Risk management examples:
Submitted electronic clinical incident forms for delays to surgery resulting from portering issues which helped to reduce delays in operating theatres.
Presented at mortality and morbidity meetings undertaking root cause analysis of a critical incident.
Patient public involvement, e.g. involved in patient recorded outcome measures as part of the RCT I was involved in.
IT and using information, e.g. IT training in a hospital trust. Implemented change as part of an audit to prompt pharmacy prescribers of the need to undertake VTE checks and prescribe if required to ensure adherence to NICE guidelines.
7). Staff and staff management: e.g. helped cover rota gaps. Helped support new foundation trainees with induction.
What is the WHO Surgical Checklist?
It is a checklist designed to improve surgical safety. It identifies three phases of an operation, each of
which corresponds to a specific period. Before the induction of anaesthesia; the ‘sign in’, before the
incision of the skin; ‘time out’, before the patient leaves the operating room; the ‘sign out’. In each phase,
a checklist coordinator must confirm that the surgical team has completed the listed task before it
proceeds with the operation.
What are the 3 components of the WHO checklist?
1) Before Anaesthesia
The patient is asked to confirm their identity, the consent form and the site of operation are checked,
and the procedure confirmed. The side of operation must be marked. Patient allergies are checked, the
amount of expected blood loss discussed, and anaesthetic safety check completed.
2) Before the first incision entire team pause and one of the members, normally the surgeon or anaesthetist,
will read out the “time out”. Everyone must introduce themselves stating their name and role. The
surgeon and anaesthetist must then confirm the name of the patient and the procedure taking place, its
site and side, and discuss any anticipated critical events, and equipment needed. Antibiotic prophylaxis,
patient warming, VTE prophylaxis (TEDS and Flowtrons), hair removal and diabetic control are all
considered on case by case basis.
3)After the operation, before the patient leaves theatre there is a further check conducted by the scrub
nurses. The instrument, swab and needle counts are checked, any faulty equipment is noted and
specimens are appropriately labelled and sent. The surgeon, anaesthetist and nursing staff then mention
key concerns for recovery.
Describe any classification systems for risk of death under anaesthetic
American Society of Anaesthesiologists to quantify the
risk of mortality during and immediately post anaesthetic. It takes into account the premorbid state of
the patient and general physical status. It was introduced into clinical practice in 1963 with five clinical
categories.
What is NCEPOD and how has it impacted on current surgical practice?
NCEPOD stands for the National Confidential Enquiry into Peri-Operative Deaths. It has made
suggestions to improve surgical safety, particularly during emergency surgery. It has for example
suggested that operations should not take place out of hours if they can be avoided. This has changed
practice in the UK.
What are the CEPOD categories, and what are they used for?
There are 4 CEPOD categories or codes that characterise an operation’s urgency. They are immediate,
urgent, expedited and elective. It allows the clinicians and managers who are responsible for allocating
theatre time to prioritise accordingly, and to ensure patients are operated on within the appropriate
time frame.
What is the difference between sterilisation, disinfection and cleaning?
Sterilisation is the eradication of all organisms including bacterial spores and viruses
Disinfection is the eradication of most microorganisms; bacterial spores and some viruses may survive.
Cleaning is the physical removal of obvious dirt and contamination without eradication of any
organisms.
What is the Data protection act?
Legislation produced in 1988, which contains
rules governing the protection of an individual’s personal information.
The main principles can be divided into two main areas. Firstly - the way in which information is stored:
it must not be kept for longer than is necessary, and while being stored it must be kept secure - for
example, use of an encrypted USB stick when being transferred. In addition, it must not be transferred
outside of the UK adequate protection. Secondly - how the information is used. In addition, the Data Protection Act allows individuals to access their information, provided the request
is made in the correct way. The Data Protection Act is extremely important in medicine. Patients trust us with extremely personal
information, and so we must endeavour to protect it and maintain this trust.
