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Audit Cycles Of The FY1 On-Call Job List Dr. Pippa Woothipoom & Dr. Kyle Stewart, Foundation Year Two Doctors PROBLEM AND AIM Many of the jobs added to the Foundation Year One (FY1) on-call job list at Torbay Hospital, South Devon, could have been completed by the patient’s team during the day. This has lead to an extensive job list for the on-call team which cannot be managed efficiently. The aim of this audit was to quantify the preventable jobs added to the FY1 on-call electronic job list (i.e. Infoflex) at Torbay hospital, which has approximately 300 medical beds and 160 surgical beds. AUDIT STANDARD Preventable jobs should take up no more than 10% of the total FY1 on-call job list. METHOD All jobs put on the on-call FY1 Infoflex job list in the month of January 2011 (total of 2844) were taken from the Infoflex archive and individually categorised by their description into 20 job codes, allowing them to be sorted and analysed. RESULTS The table below gives a breakdown of the 2844 jobs put on the FY1 Infoflex job list in January 2011. Review bloods Prescribe 19.2% warfarin Routine reviews 12.2% Venflon Prescribe fluids 11.0% Acute reviews 7.0% Bleed patient 3.6% Unknown 6.9% TTA 3.3% Verify death 0.6% 6.3% Review fluids Prescribe 1.5% fragmin 0.4% 1.4% Clerking 0.4% 1.0% Discussion 0.3% Prescribe meds 8.2% Review meds 4.6% Review scan Drug chart 4.1% 7.1% Discharge review Review fragmin 0.8% The graphs below show the average breakdown of jobs for a medical or surgical FY1 per shift. (DC = re-write drug chart, TTA = discharge summary/discharge medications, Disc rv = review for discharge). 29.4 Average Job Breakdown For Weekend Shift On-Call DISCUSSION A large proportion of jobs added to the on-call FY1 job list could have been completed by the day team, including: • Prescribing warfarin • Amending / re-writing drug charts • TTAs • Reviewing bloods – especially weekdays • Prescribing fluids – especially weekdays • Bleeding patient – especially weekdays Preventable jobs accounted for 1371 of the 2844 job total in January 2011 (48% of the FY1 on-call workload, compared to the 10% standard). This figure was made up of 40% of weekday jobs and 53% weekend jobs. RE-AUDIT Several different checklists to keep track of ward jobs were created for FY1s on two trial wards. It was felt by these doctors that a checklist would create more work and they were reluctant to try them. Instead, the results of the audit were discussed with the current FY1s and they were verbally encouraged to complete all jobs during the day as able. Following this, a two week re-audit between 23rd April and 5th May 2011 was undertaken. Only the preventable jobs as outlined above have been included in the graph below. As it is more likely that bleeding patients, reviewing bloods and prescribing fluids will be required on a weekend, they have not been included as weekend preventable jobs. Identical methods of data collection were used for the re-audit. Comparison Of The Number Of Preventable Jobs On An Average On-Call Shift In January And April 2011 16 14 20 12 18 16 14 January 2011 April 2011 (re-audit) Medical jobs total: 114.5 Surgical jobs total: 74 10 8 12 10 6 8 4 6 2 4 0 2 Px warfarin DC TTA Rv bloods Px fluids Px warfarin DC Bleed pt TTA 0 Weekend Jobs Average Job Breakdown For Weekday Shift On-Call 4 Medical jobs total: 29.9 Surgical jobs total: 15.8 3 2 1 0 Weekday Jobs RE-AUDIT DISCUSSION There was a significant improvement in both weekend and weekday preventable job counts. This may reflect better planning by the day team. It could also reflect a seasonal difference. A more permanent intervention is currently being tested on two trial wards. A ‘Doctors to do’ column has been added to the ward’s electronic patient white board which flags up outstanding jobs to be completed by the end of the day. The aim is to help day teams manage their ward work in a timely fashion, thereby reducing the work load for on call doctors. A new warfarin chart has also been designed to help enable day teams to prescribe ahead for the weekend. CONCLUSION Almost half of all jobs added to the FY1 on call Infoflex job list at Torbay Hospital in January 2011 were preventable. This may be due to poor organisation by the day teams on busy wards. On call doctors should not be asked to carry out simple ward tasks which should have been completed during the day. In the short term verbal encouragement showed some improvement, however it is hoped that the ‘Doctors to do’ column and involvement with the ward improvement group will help reduce job numbers further. [email protected], [email protected]