After Hours Care and Safety

After hours work can be an area of nerves for the new junior doctor.  In this podcast we discuss after hours work, care and safety, explore available resources to be aware of and escalation plans that can help ease the stress.

Summary Writer:  Eloise Sobels

Script Writer:  Eloise Sobels

Editor:  Sonia Chanchlani

Interviewer:  Eloise Sobels

Interviewee:  Sonia Chanchlani

 

About Dr Sonia Chanchlani

Balancing clinical forensic medicine and training with the Royal College of Medical Administrators across Western Australia, New South Wales, and Queensland, Sonia Chanchlani completed a dual Masters in Health Management and Public Health alongside research into interventions to promote clinician wellbeing. Advocating for junior doctors and enabling a safe working environment led to her being appointed as the Director of Clinical Training at the Royal Brisbane Women’s Hospital prior to her current role as the Chief Medical Officer at MedApp working closely with organisations to ensure governance, clinician engagement, and wellbeing are prioritised.

 

About Eloise Sobels

Eloise is a final year medical student at the University of Sydney, New South Wales. She is currently completing her clinical years based at the Royal Prince Alfred Hospital. Before embarking on her Medical degree, she completed an undergraduate in Medical Science (Hons) from Flinders University and worked in a Clinical Pathology Laboratory testing and reporting on blood results. Ellie has a passion for team-based medical care and is currently working on research into Multidisciplinary Team based care for End-Stage-Kidney-Disease patients. Ellie is an avid dog lover and enjoys any beach related activity, as well as playing hockey for the University of Sydney.

After Hours Care and Safety

With Dr Sonia Chanchlani, Clinical forensic physician, trainee with the Royal College of Medical Administrators and Chief Medical Officer at MedApp, Australia

 

Introduction

After hours work can be an area of nerves for the new junior doctor. Being aware of resources and having clear escalation plans can help ease the stress. Whilst there are limitations to after hours work there are also benefits when this is done in an environment that supports clinicians. In this podcast we explore these themes and how you can get involved with organisational change projects.

  • Any work outside normal working hours of 8am-6pm
  • This includes evenings, nights, all day weekends and public holidays
  • Junior doctors make up the majority of the on-site workforce.
  • More senior clinicians are rostered on for phone advice
  • Between different wards there can be different staff, in the ED there will be a range of roles working these shifts, but generally the ward doctors will be junior.
  • Most of the roles and responsibilities are reactive
  • Including acute patient deterioration, attending any patients of concern, admissions, or ward-based procedures
  • Increased autonomy
  • Exposure to diverse cohort of acute patients
  • Good learning opportunities
  • But these environments should provide the right type of emotional and physical support for all clinicians involved.
  • Juniors can feel quite busy, having limited handover and communication opportunities
  • Dealing with patients that aren’t their own (unfamiliar patients with unfamiliar conditions)
  • Overall, it can be overwhelming and stressful.
  • In general, studies have shown that shift work can cause a disrupted work-life balance and there can be a sense of isolation with a lack of a team environment.
  • Multiple studies looked to understand the underlying causes of ‘The weekend effect.’
    • It has been shown that there is a higher mortality rate for patients admitted as emergency cases on weekends
    • This is combined with the trend of decreasing staff numbers after hours – fewer doctors, more junior, working with less experienced medical staff on the ward and access to limited support services can be compounded
  • Key elements have been missing in key organisations or processes to create the optimal environment for patients and staff
    • Unclear roles and responsibilities for hose on the floor
    • Unclear handover
    • Unclear escalation strategies
    • Maldistribution of workload
  • There are ‘on-call’ textbooks and now apps
  • Some hospitals have local guidelines for after hours work
  • MedApp looks to put all this information and more at the fingertips to those who need it most.
  • It is a blank slate where hospitals can purchase the App and upload all the relevant clinical and organisational guidelines that your clinicians need to do the job.
  • Specially in the after hours environment, the App is populated with after hours common calls, escalation strategies, clinical procedures and protocols.
  • Local organisational elements such as hospital maps, where to park for an after hours shift and even where to find healthy treats at 3am!
  • A very resource-heavy App crucial for clinicians and patient care.
  • Digital has really improved the after hours work including resource access and senior clinicians looking at results at home.
  • Away from digital, there’s adequate rostering with differing experience and skill mix of clinicians, clear breaks for eating and hydration, very clear and easy to access escalation pathways, access to support networks, textbooks, posters clarifying roles and responsibilities.
  • When I was a junior, I could see my patients and colleagues constantly experiencing challenges and barriers within the hospital and in the community I was working.
  • I signed up to hospital change and improvement projects, I was always putting my hand up to do a roster review, or I actually created our hospital’s after hours survival guide on a word document.
  • Getting involved with these projects lead me to switch from GP training to medical administration where I could influence the health system on a larger scale and hep a larger number of clinicians and patients.
  • I have since participated in a few major after hours improvement programs across a lot of Australian hospitals.
  • A few years ago, I was introduced to MedApp when I was the director of clinical training at the Royal Brisbane Hospital. I remember thinking as soon as I saw it, ‘Omg where has this App been all my life?!’ Because I could recognise the benefits of it for this workforce, and that ultimately lead me to where I am today with MedApp team and supporting clinicians both national and internationally.
  • I can’t stress the importance enough of good documentation and handover
  • Identifying the at-risk patients and ensuring a clear management and escalation plan in place for those clinicians taking over the shift.
  • The emotional and physical impact an after hours shift can take should not be taken lightly.
    • Ensure you are well rested, fed and hydrated
    • Don’t be afraid to ask for help
    • A kind word and a helping hand to your team
    • Be kind to yourself and each other
  • Look after yourself and each other.
  • I really want to advocate for doctors of all levels to be part of the change you want to see in the healthcare system.
  • Take the initiative, review and reflect the gaps in your workplace and demand change when it is necessary.
  • Do this by getting involved with organizational change projects by talking to your consultant or director of education.
  • Because I can’t stress enough that junior doctor leadership is so powerful and I can already see the face of Australian medicine changing due to the courage and initiatives of all clinicians.

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Tags: #acute care,#after hours care,#Emergency Medicine,#General Practice,#handover,#junior doctors,#leadership,#MedApp,#on call,#wellbeing,#worklife balance

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