Improving Patient Safety with the Introduction of Weekly Complex Patients Meeting
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Authors
Tan,L. E.
Agarwal,A.
Bensted,R.
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2024
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Conference Proceedings
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Objectives Paediatric inpatients with a complex medical and social background often require individualised input from various teams. For the purpose of our Quality Improvement, 'complex' inpatients will imply those with a >1 week stay, with diagnostic dilemma, or whose care involve >2 subspecialties. Our main aim is to improve patient safety and the quality of care for complex inpatients, by introducing weekly complex patients' meetings (CPM), which will involve all general paediatric consultants and junior doctors. Methods We designed surveys for all general paediatric consultants and junior doctors to complete, before and after the introduction of weekly CPM. The surveys include three main aspects - patient safety and quality of care, communication and teamwork, as well as education and training. 15 doctors responded to the survey before CPM introduction, and 12 doctors responded to the survey after introducing CPM. The survey comprised of 12 questions, and the participants ranked on the scale of 1 (strongly disagree) to 5 (strongly agree). Results 40% of doctors felt that they knew the complex inpatients well prior to CPM introduction, and this increased to 83% after introducing weekly CPM. 13% of doctors strongly agreed that complex inpatients' care and management were optimal before introducing CPM, in comparison to 75% who now strongly agree to the statement. 46% of doctors disagreed or strongly disagreed that there was optimal flow and discharge planning for complex patients prior to CPM introduction, but 91% now agree or strongly agree that the weekly CPM have helped with optimising flow and discharge planning. Only 33% of doctors felt that communication within the general paediatric team was optimal, and now with the introduction of weekly CPM, 100% of doctors agreed that there is better communication within the team. Only 13% of doctors previously felt that trainees were given ample learning opportunities about the complex inpatients, but with the introduction of weekly CPM, 100% now felt that they were given more opportunity in this area. Conclusion Weekly complex patients' meetings have proven to be beneficial in many aspects. Many doctors felt that they know more about the complex inpatients, and the weekly meetings have helped with discharge planning due to effective information sharing within the team. Communication is vital for patient safety, and the weekly meetings have markedly helped with that. Finally, CPMs have also provided trainees with more educational and learning opportunities, and this will further improve our experience during training. We recognised that this could save time and lead to a more consistent investigation of hypoglycaemia. The order set also assists investigators by providing prompts/warnings for iced samples, length of time from sampling to lab and advice on tests that need completing as point of care testing at the same time. We have printed and laminated the necessary investigations to be stuck on the walls of the treatment room in our Neonatal unit (as a visual aid for the investigator to help assemble their equipment quickly). Pre-made investigation packs were not favoured by the team because of the risk of sample bottles being removed, lost or not kept up to date Results The hypoglycaemia screen order set is now live on the IT system along with the physical visual aids. This was also shared with our Paediatric ward and we have increased awareness by sharing with all during handover meetings. The feedback has been positive so far with regards to being easy to use as well as educational, especially for non- career paediatricians that work on our Tier1 rota. This has made the investigation process less time consuming and more effective in terms of completion and patient safety.1 Figures 1 and 2. Conclusion In a Quality improvement project, we created an order set in the local IT system for babies with persistent hypoglycaemia to make the process quicker and enable more consistent investigations. Preliminary feedback - to be confirmed in serial audits over the next 18 months - suggests that those colleagues working out-of-hours and who are non-career paediatricians are finding this to be of most benefit.
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Archives of Disease in Childhood