1. Dr Toolbox: Enabling trainees
Dr Will Barker

2. Cost benefit 60 doctors in training - Pay £20 per hour
Using the reported time saved (i.e. 40 minutes per day) a simple calculation demonstrates the benefits that can be accrued:
60 doctors in training - Pay £20 per hour
Benefits accrued over course of one year (250 working days)
60 (doctors) * 0.66 (hrs) * £20 (hourly rate) * 250 (days)
£200,000 per hospital
Organisational amnesia, the loss of knowhow and improvements with each change of doctors is prevented.
It also saves stacks of paper with each induction.

3. I can’t remember any of this from induction!”
Why Dr Toolbox
“It’s 0930 on Day 2 into working here and the Consultant already seems cross with me…
The SpR is in clinic and I need to book an endoscopy for an upper GI bleed, a Contrast CT, refer to the respiratory team and get a critical care review…
I can’t remember any of this from induction!”
So let me begin with a real life scenario.
Who do you go about asking how to get these things done. Everybody seems to think its done a different way, you feel like you are wasting the time of the seniors asking how to get inane things done. And then when you realise you need the form, you don’t know where the form is kept, and in all likelihood it won’t tell you what number you need to send it off to. This sort of knowledge, if you are anything like the F1’s at my trust takes up a considerable part of your day, and certainly had nothing to do with the knowledge you spent years filling up your brain at med school

4. Is this the best we can do in 2016?

5. Why Dr Toolbox
2009 study identified 6% increase in mortality in August [1]
‘The intention is to end the so-called killing season.
This is good news for patients.
We recognize the change-over period in August puts patients at risk’
Statistics and Bruce Keogh on the same page.
2004
2014

6. In summary
Starting in a Hospital as a Junior Doctor is a bewildering and stressful period
Common tasks are often more difficult than they should be and include:
Requesting many different tests
Making referrals to many different specialities
Using hospital guidelines that are difficult to find
More time (and stress) is often spent finding out how to do such tasks rather than actually doing the tasks themselves.
How can we provide an innovative solution to this
IT intranets within hospitals often contain such information which is: Difficult to find, Difficult to update and seldom updated, Not specific to Junior Doctors
So specifically looking at improving the efficiency of junior doctors by providing a readily accesible site with specific local information on what to expect in your firm and how to get things done
Patient safety is compromised, time is wasted and stress is incurred if these tasks are done incorrectly
Spending less time on these tasks, would mean more time available on items relevant to the post-graduate curriculum and our learning
So what were our aims. Well to look at handover. That’s not handover at the end of the day, but handover at the end of the year.
And along the same lines the intrinsic loss of local knowledge that doctors lose every fours months between rotations.

7. Primary Aims
Provide specific, local information on how to get things done in hospitals
Improve the efficiency (and learning environment) of junior doctors. Increasing time for training
Improve patient safety by
facilitating a better handover
between rotating doctors
So what were our aims. Well to look at handover. That’s not handover at the end of the day, but handover at the end of the year. And along the same lines the intrinsic loss of local knowledge that doctors lose every fours months between rotations. So specifically looking at improving the efficiency of junior doctors by providing a readily accesible site with specific local information on what to expect in your firm and how to get things done
Shift work has diminished the traditional apprenticeship of junior doctors and fragmented training. Attending teaching is contingent on completing work quickly and efficiently in rota’d hours.
Getting things done with wtd restricted week. Supplementing local induction. Very important for locums, and doctors starting new firms
Maximising the time for training
Our project is about patient safety and sustainable. Temple report “Training is patient safety for next 30 yrs”.

8. So what is Dr Toolbox? So here’s a demo
In brief the Toolbox is a website, similar to Wikipedia type format that we provide as a template for junior doctors to set up at their trusts.
It’s password protected and contains all the useful information specific to junior doctors. If you want to know the bleep

9. What is Dr Toolbox?
Dr Toolbox us your portable and paperless local induction
When you change jobs, a new doctor can continue your work without compromising patient care
“Wikipedia, but for your hospital”  

10. Baseline information
2/3 disagreed that induction covered all they needed to know.
Around 80% wanted more information on how to contact medical teams, the MDT and making referrals
More than half did not know what was expected of them

11. Toolbox includes Handover guides for all firms Bleeps
Extension numbers
How to make speciality referrals
within the hospital
How to request specific investigations
Reference guides specific to the hospital
A resource for teaching
And post graduate medical education

12. Toolbox is: Password protected Easily updatable
Specific to Junior Doctors working at individual hospitals
Available on
a mobile phone
hospital intranet or
a home computer

13. The map now

14. Outcomes Trust Survey: 81.0% of F1s surveyed have used it
‘Not only the junior doctors, but also nursing and administration staff, registrars and consultants have seen the site and have been very impressed’
Trust Survey:
81.0% of F1s surveyed have used it
Of those users:
93.8% found it a useful way to access information
100% felt it saved them time
Self reported time saved:
Mean = 39 minutes per doctor per day
Statistically significant in changing actions
F1s are less likely to contact senior for help on basic tasks (p < 0.05)
Analytics:
Approx 2000 page views per month at single Trust
‘I re-audited the Toolbox, and it show increased awareness, usage and satisfaction…
‘I have shown [the Toolbox] to every new member of staff as well as locums, and I am aware that it is being used by the MDT at all levels’
So do we have any data
This is just from one trust and we are currently combining the data from others and looking to publish the results
We have found that it has been associated with changed outcomes, in that following its introduction doctors
But apart from just numbers what qualititative measures have we got back….
55% contact senior prior to implementation, falling to 18% post introduction, 47% now use toolbox,

15. Two years on 100 Dr Toolbox sites Endorsement by NHS Medical Director
40 new sites over the last year
Over 500 Doctors involved in programme
Endorsement by NHS Medical Director
Health Education England
Inspire Improvement BTBC
£15,000 to develop an app
Education and Training
NW Thames Leadership Programme
South Thames Leadership Programme
After a launch in October 2013, six further trusts in NW Thames are currently working to sett up their own sites to launch for the August changeover. Simultaneously around 30 separate trusts are currently setting up sites across the country. We have engaged Foundation Directors for further ‘Leadership Programmes’ in North Central London and South London in the following year.
Managing a larger sized project
Being inundated with requests for new sites
Over a hundred doctors involved in one way or another
Balancing projects with training
Senior (permanent) staff input is critical
Local ownership
Build into plan sustainability & handover
Make projects simple at the start….

16. Summary Points A product that will benefit the NHS ✅
Improve quality of care ✅
Improve efficiency and sustainability ✅
London based but national and international scope
For clinicians by clinicians ✅
So in summary
Use of innovative learning technologiesthat promotes continuous improvement in the safety and quality of patient care
We have sought to provide a continuous learning environment, one that promotes continuous improvement in the safety and quality of patient care
Rather than having a paper guide that gets lost in the wash we have attempted an innovative approach to learning technologies
We have involved not just rotating junior doctors and permanent consultants but also encouraged an environment that promotes the role of the MDT and what we can learn from them
We have sought to embody a leadership initiative that has work based activities at its heart
Its benefits include both the development needs of the individual whilst also helping service provision efficiency
How to train the best Doctor might not always be knowing the textbooks inside out; but enabling them to be efficient and task orientatied
Promotion of multiprofessional and/or interprofessional education initiatives
Development of a learning programme that promotes excellence amongst new and/or experienced faculty
The site uses an innovative learning technology to provide readily accessible, specific information to doctors at no cost to hospitals. With constraints such as the European Working Time Directive, time available during the week is shortened. Thus projects such as this can help reduce time wasted on tasks that have no benefit to training, whilst also improving efficiency in service provision. Free time could then be spent at the bedside, in theatre and gaining competencies relevant to the post graduate curriculum.

17. Where now?
Most people overestimate what they can do in one year… and underestimate what they can do in ten years

18. Thanks!
dr-toolbox.com