Dr Toolbox: Enabling trainees

Improving Care with TechnologyBetter Training Better Care

Will Barker, James Houston

dr-toolbox.com

22th January 2015

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 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!”

Is this the best we can do in 2015?

Why Dr Toolbox

2004 2012

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’

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.

So what is Dr Toolbox?

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 – And post graduate medical education

Toolbox is:

• Password protected • Easily updatable• Specific to Junior Doctors working at individual hospitals• Available on

– hospital intranet, – a home computer or – a mobile phone

• Simple to set up for other NHS trusts

• Scalable to other members of the MDT

Outcomes

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

Two years on

• 65 Dr Toolbox sites– 40 new sites over the last year– Over 200 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

New Dr Toolbox sites

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 SurveyEnsure continuity

Launch

Gather relevant bleeps and extensions nos

December Changeover

The map now

Summary Points for Dr Toolbox

• Readily scalable nationally• Readily scalable to other members of the MDT• Partnership with private sector and open-source• Minimising avoidable patient harm as a result of errors

when booking investigations or referrals.

Inspiration

Larry Page (Co-founder Google)

You don’t need to have a 100-person company to develop that idea

Bill Gates

Most people overestimate what they can do in one year and underestimate what they can do in ten years

Thanks!

References:1. Jen MH et al. Early in-hospital mortality following trainee doctors' first day at work. PLoS One. 2009 Sep 23;4(9):e71032. Keogh. B. Lives will be saved as junior doctors shadow new role - Press releases - GOV.UK 3. Frazer L. Why you should use your foundation year 1 to create a safe handover document. BMJ Careers4. Goldacre M. Foundation doctors’ views on whether their medical school prepared them well for work: UK graduates of 2008 and 2009, doi:10.11365. Houston J, Barker W, Clarke J, Mew E. Sharing knowledge, saving time: an online toolbox to aid junior doctors BMJ Quality Improvement Reports 2014; u200583.w651 doi: 10.1136/bmjquality.u200583.w651

dr-toolbox.com