1. Forging Foundations Together Will Barker James Houston www.dr-toolbox.com 4 th April 2014

2. “It’s 0930 on Day 2 into working here and the Consultant already seems cross with me… The SpR is in theatre and I need to book an outpatient clinic, a Contrast CT, refer to the respiratory team and get a pain team review… I can’t remember any of this from induction!”

3. 20042012 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 recognise the change-over period in August puts patients at risk’

4. Shadowing periods –information overload –many unknown questions still at end –new questions arise post changeover Paper guides –frequently lost –quickly out of date –cumbersome to carry around

6. Starting in a Hospital as a Junior Doctor is a bewildering and stressful period in your career! 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.

7. IT intranets within hospitals often contain such information which is: –Difficult to find –Difficult to update and seldom updated –Not specific to Junior Doctors 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

8. 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

9. “If only there was an accessible guide to the hospital With local information on how to do daily jobs written by junior doctors for junior doctors…”

10. http://dr-toolbox.com/Demo

11. Handover guides for all F1/F2 firms Bleeps of doctors & MDT Extension numbers for wards, secretaries Reference guides specific to the hospital How to make speciality referrals –within the hospital How to request specific investigations –within the hospital A resource for teaching –And post graduate medical education

12. Password protected Easily updatable Specific to Junior Doctors working at their individual hospitals Available on –hospital intranet, –a home computer or –a mobile phone Simple to set up for other NHS trusts

13. 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

14. 81.0% of F1s have used Toolbox Of those Drs that used the Toolbox 94% found it a useful way to access information 100% felt it saved them time Self reported time saved (per day): –Mean = 39.4 minutes –SD = 17.8 mins Analytics: Approx 2000 hits per month

15. F1’s are less likely to contact senior when finding out how to request a test after 1 month (p = 0.015) F1’s are less likely to contact a senior when finding out how to make referrals after 1 month (p = 0.001) Method to be used by F1’s when Finding Out how to Request a Test

16. Renamed Dr Toolbox –But are very grateful to DAPS Endorsement by NHS Medical Director –Sir Bruce Keogh Health Education England –Inspire Improvement BTBC –£15,000 to develop an app 35 Dr Toolbox sites –25 new sites over the last year –NW Thames Deanery leadership programme –SW England, NW England, Northern Ireland

17. https://www.youtube.com/watch?v=fW8amMCVAJQ

18. Set up a Toolbox for your Trust Complete your own QI Project Develop your leadership skills YOUR TRUST NEEDS

19. Finalise site & add to intranet Set up roles within Team Baseline survey Send out forms for handover guides Begin to input data Upload common forms Repeat Survey Ensure continuity Launch Gather relevant bleeps and extensions nos December Changeover

20. Managing a larger sized project Being inundated with requests for new sites Trouble-shooting takes up more time Over a hundred doctors involved in one way or another, so we need to find new ways of co-ordination Members of the team have moved Balancing projects with training Children!

21. Watch this 5 minute video on implementing technology https://www.youtube.com/watch?v=C1CP0HJtlRk

22. Projects aren’t just some tickbox in the CV for juniors Senior (permanent) staff input is critical Local ownership Build into plan sustainability & handover Make projects simple at the start….

24. Stick with it, good times and bad times Rotations can be advantageous to spread good ideas Think about the resources needed to sustain your initiative Don’t be afraid to get your hands dirty making websites –but it helps to know at least one expert Web apps & tablet computers are now very reliable and affordable –huge opportunities to improve care and work environment Support your champions Challenge people who say it cant be done –but don’t waste time trying to change their minds

25. References: 1.Jen MH et al. Early in-hospital mortality following trainee doctors' first day at work. PLoS One. 2009 Sep 23;4(9):e7103 2.Doctors Advancing Patient Safety (DAPS) www.dr-toolbox.com