1. The Medical Registrar Review Smartboard Improving the ED to Medicine Pathway Elinor Shuttleworth, Laila Maat, Rebecca Lee, Claire Robertson The University Hospital of South Manchester

2. The problem… ED or GP Over 100 bleeps in 24 hours 2 to 4 bleeps and 10-20 minutes per referral

3. The problem… ‘Constant interruptions for routine referrals mean that there is much higher potential for missing critical results or elements of the management plan when seeing the most unstable patients, which is a key part of the SpR's job. When junior doctors are not always aware of whom to see next this adds to delay in seeing patients and could compromise safety.’

4. The problem… Hospitals should reduce the burden of administrative and basic clinical tasks by appropriate redistribution of this work to other staff. Freeing up the medical registrar from these ‘non- priority’ jobs will allow them to care for the most unwell patients and improve clinical outcomes. Hospitals should utilise electronic tools to facilitate communication and handover between the medical registrar and other members of the team. The medical registrar Empowering the unsung heroes of patient care: RCP 2013

5. The solution… We asked ED We asked Medical SpRs We looked at other successful systems in the region We got the support of senior management We formed a guiding team of key stakeholders

6. The solution… The Medical Registrar Review Smartboard

7. The impact…

8. Nov 12 – Apr 13 (Total) Nov 13 – Apr 14 (Total) Nov 14 – Apr 15 (Total) Total ED attendances 457694666747158 Average time to see ED doctor 73 minutes 68 minutes

9. The impact… In the words of one Medical Middle Grade – “More patient time, less time spent on the phone. I am finally a doctor instead of a secretary.”

10. Key learning points… Ask the people who do the job every day Get the right people on board early And meet often Be persistent Keep remembering the reason why you started Don’t expect everyone to love change!

11. Thank you for your time Any questions?