Dr Toolbox: Enabling trainees

1. Dr Toolbox: Enabling trainees Forging Foundations Together Will Barker James Houston 4th April 2014 www.dr-toolbox.com

2. Why Dr Toolbox “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. 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 recognise the change-over period in August puts patients at risk’ 2004 2012

4. Previous attempts • 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• many unknown questions still at end • new questions arise post changeover • Paper guides • frequently lost • quickly out of date • cumbersome to carry around

5. Is this the best we can do in 2014?

6. Problems identified & background • 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. Problems identified & background • 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. 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

9. The idea “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. So what is the Dr Toolbox? http://dr-toolbox.com/Demo

11. Toolbox includes • 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 • Andpost graduate medical education

12. Toolbox is: • 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. 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

14. Results after Implementation at one Trust • 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. Changing Actions: • 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. One year on • 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. The first follower • https://www.youtube.com/watch?v=fW8amMCVAJQ

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

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

20. Challenges faced • 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. How to innovate. • Watch this 5 minute video on implementing technology • https://www.youtube.com/watch?v=C1CP0HJtlRk

22. Building Sustainability • 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….

23. The map now

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