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
Increased need for clinician confidence regarding referral to secondary services
Do: Creation of a referral handbook
Study: analysis of data demonstrated the increased confidence of clincians ability to know how to contact specialist services for advice and better manage patients
Reduced steps in the treatment pathway with overall cost savings.
Act: Guidelines uploaded onto trust guidelines
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.
What is the European Working Time Directive
Came into effect in 2009
The EWTD requires the working week to be an average of 48 hours, with further rights relating to break periods and holiday allowance, such as:
11 hours rest a day
a day off each week
a rest break if the working day is longer than six hours
5.6 weeks paid leave each year.
What are the pros and cons of the EWTD
Pros:
✅ Better Rested Doctors – Reduced working hours mean doctors are less fatigued, leading to safer patient care.
✅ Improved Work-Life Balance – Doctors can maintain a healthier personal life, reducing burnout.
✅ Legal Compliance – Ensures that working conditions meet legal requirements, protecting both staff and patients.
Cons:
❌ Reduced Training Time – Shorter shifts mean fewer hours for skill development, potentially leading to less experienced consultants in the future.
❌ Loss of Continuity of Care – Shift-based rotas mean doctors don’t consistently care for the same patients, impacting patient experience.
❌ Lower Pay for Junior Doctors – With banding over 50% removed, many junior doctors face significant pay cuts.
❌ Less Responsibility & Engagement – Doctors on shift work may feel less accountable for patients they don’t see regularly.
Define
1) Incidence
2) Prevalence
Incidence measures the number of new cases
in a specified time period in a specified population.
Prevalence is a measure of all the cases in a
population at a given point of time.
Define Sensitivity, Specifcity, Positive Predictor Value and Negative Predictor Value
Sensitivity is the probability of testing positive when a disease is truly present
Specificity is the
probability of a test screening negative if the disease is truly absent
Positive predictive value is the proportion of subjects with positive test results who are correctly
diagnosed as having the disease
Negative predictive value is the proportion
What is screening?
Screening is a strategy used to identify disease or pre-disease in currently asymptomatic individuals. It
is an attempt to identify disease in a population early, to allow earlier intervention, at a stage when the
disease can be treated.
What makes a good screening program?
What makes a good screening programme?
The World Health Organisation Principles of Screening suggests that:
* The condition should be an important health problem.
* There should be a treatment for the condition.
* Facilities for diagnosis and treatment should be available.
* There should be a latent stage of the disease.
* There should be a test or examination for the condition.
* The test should be acceptable to the population.
* The natural history of the disease should be adequately understood.
* There should be an agreed policy on whom to treat
* The total cost of finding a case should be economically balanced in relation to medical expenditure
as a whole.
* Case-finding should be a continuous process, not just a “once and for all” project
What are criticisms of screening?
Problems with Screening:
High Cost & Resource Use – Screening diverts NHS resources to people who may not need treatment.
False Positives – Can cause unnecessary anxiety and further tests for healthy individuals.
False Negatives – May miss disease, leading to false reassurance.
Discomfort – Some procedures, like colonoscopy, can be unpleasant.
Overdiagnosis – Detects cancers that may never have caused harm (e.g., prostate cancer).
Biases in Screening:
Lead Time Bias – Detects disease earlier without improving survival, prolonging worry.
Length Time Bias – More likely to detect slow-growing, less aggressive cancers.
Selection Bias – Participants in screening tend to be healthier and wealthier, skewing results.
What is a null hypothesis
A null hypothesis is a default or general position. An example would be to say that there is no
relationship between two variables or that one outcome was not a result of a certain factor.
What is a confidence Interval?
A confidence interval indicates the reliability of an estimate. It is based on a sample of quantitative data.
It defines the frequency of a parameter being contained within a certain interval. Example, if the mean
in a population sample was 60, and the upper and lower limits of the 95% confidence interval are 65
and 55 respectively,
What is a gaussian distribution?
A normally distributed data. normal distribution and is one of the most
commonly illustrated probability distributions in statistics. It always represents continuous,
quantitative data. It is a distribution where the pattern of distribution above and below the mean is
identical. It forms a classical ‘bell shaped probability density function’ and is commonly encountered
in social and medical science
What is clinical governance? What is your experience?
Clinical governance is a process of quality assurance to ensure that standards of care are improved and
that public accountability is maintained. It is based around 7 pillars which are Clinical effectiveness and
Research, Audit, Risk management, Education & training, the use of IT, Medical staffing and Patient
and public involvement.
- Audit at QVH on Comparision of Outcomes
- Teaching programme for Kings
- T & O LFG Representative
What are the types of consent used in the NHS?
Form 1 Patient agreement to investigation or treatment (adults with capacity)
Form 2 Parental agreement to investigation or treatment (i.e. for children)
Form 3 Patient/parental consent for procedures where consciousness of the patient is not impaired
(i.e. patient is alert throughout the procedure)
Form 4 Adult unable to consent for investigation or treatment (i.e. lack capacity
What does consent normally Involve?
Condition – The doctor assesses the patient through history, examination, and investigations, then explains the diagnosis.
Options – The doctor discusses treatment options (conservative, medical, surgical) with risks and benefits, including the choice of no treatment.
Informed Decision-Making – The patient considers the options and communicates their decision.
What is revalidation?
Purpose – Ensures doctors are up to date, fit to practice, and identifies those needing support.
Legal Requirement – Introduced in 2012, required every five years.
Process – Based on regular appraisals covering four
GMC domains:
Knowledge, skills, and performance
Safety and quality
Communication, partnership, and teamwork
Maintaining trust
For Trainees – The postgraduate dean (LETB) makes the revalidation recommendation based on ARCP assessments.
How would you as a surgical trainee provide evidence for the revalidation process?
During my surgical training, I would use the Intercollegiate Surgical Curriculum Portfolio (ISCP) to
record evidence of my ongoing training and professional development as well as feedback from 360
degree appraisals. My responsible officer would then assess this evidence at my ARCP before making
a recommendation to the GMC.
40 WBAs and 120 Cases
What is a Datix?
Datix is an incident reporting system used in the NHS and other healthcare settings to record and manage patient safety incidents, near misses, and adverse events. It helps improve patient care by identifying risks and preventing future errors.
How is Datix Used?
Incident Reporting – Staff report patient safety incidents, errors, or near misses through the Datix system.
Investigation – The reported incident is reviewed by relevant teams to assess the cause and impact.
Action & Learning – Findings are used to implement changes, improve safety protocols, and provide staff training.
Monitoring & Improvement – Trends are analyzed to prevent recurrence and enhance patient care.
Key Point: Datix is a non-punitive tool focused on learning and improving patient safety rather than blaming individuals.
