New full-shift, acute care systems being trialled for assessing and reviewing patients are compromising juniors’ training, a study shows.
The system at the Royal Liverpool University Hospital, which is in widespread use around the country, enables it to hit NHS targets but has reduced the opportunities for trainees to learn.
The hospital’s acute medicine model is a full-shift system with no integration to maintain unit links between the trainee and consultant on-call rotas.
GPs and A&E SpRs refer patients to the hospital’s acute medical unit and heart emergency centre. SpRs perform reviews of patients overnight and between consultant ward rounds in the day. There are two formal consultant-led post-take ward rounds per day in the units, ensuring consultant review of all admissions within 24-hours.
Waiting times in A&E and time to assessment by a consultant in acute settings improved with the new system. However, restrictions in working hours prevented junior doctors from being present when the patients they admitted to the wards were reviewed by a consultant. At this stage, around half of all diagnoses are changed and the current system has no mechanism for feedback to the initial assessing team.
The authors of the research, published in Clinical Medicine this week, note that the patterns of work and systems employed at the Royal Liverpool are likely to be found in other hospitals struggling to balance government targets for waiting times with the new target for reducing junior doctors’ working hours. Since 1 August, trainees are restricted to working a 48-hour week.
Dr Solomon Almond, consultant physician at the Royal Liverpool, said: “The results of our audit highlight the benefits for patients of being seen by consultants soon after admission. However, the restriction of junior doctors’ hours meant there is less time for consultants to discuss their decisions with the doctors in training.
“Ideally all emergency admissions would be seen straight away by consultants accompanied by the junior doctors. This would re-establish the link between hands-on clinical medicine, training and experience that was for many years the foundation of post graduate medical education in this country.”
Commenting on the research, Dr Andrew Goddard, director of workforce planning at the Royal College of Physicians, said: “This study shows that increasing the input of consultants into the care of medical patients admitted to hospital changes the way doctors are trained. The short term benefits to the patient of seeing a consultant first may be offset by loss of training opportunities for the consultants of the future.”
Tags: Acute medicine, Targets, Training, WTD
