addenbrooke’s hospital...dr ben warne, ct2; dr sanjay ojha, rcp college tutor east of england cmt...
TRANSCRIPT
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Dr Ben Warne, CT2; Dr Sanjay Ojha, RCP College Tutor
East Of England CMT Training Day June 2015
The CMT Can See You Now… Enabling Outpatient Experiences for Core Medical Trainees at
Addenbrooke’s Hospital
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• Training requirement
• Major training concern
• Previous unsuccessful efforts at Addenbrooke’s
• Large clinic number in own time
Background
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1. To determine important issues that prevent outpatient attendance
2. To develop a reliable method of monitoring attendance
3. To enable CMTS to meet their training requirements. Target: by May 2015, 90% of CMTs will be attending 0.5 clinics per week during their timetabled ward rotations.
Project Aims
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Plan-Do-Study-Act Cycle
Enact
interventions
Analysis of
clinic surveys,
presentation of
data
Plan interventions,
targeting key issues
or problem firms
Clinic
Surveys
sent to all
CMTs
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Measures
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Run Chart
0
0.1
0.2
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0.5
0.6
Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May
Mea
n N
o. C
linic
s A
tten
ded
per
wee
k p
er C
MT
in w
ork
ing
ho
urs
Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15
Target Attendance
//
1 3 4 5 6 2
Surveys Every 6 Weeks
Target 0.5 clinics per CMT per week
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Run Chart
0
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0.5
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Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May
Mea
n N
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linic
s A
tten
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per
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MT
in w
ork
ing
ho
urs
Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15
Clinics Attended Target Attendance
//
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Run Chart
0
0.1
0.2
0.3
0.4
0.5
0.6
Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May
Mea
n N
o. C
linic
s A
tten
ded
per
wee
k p
er C
MT
in w
ork
ing
ho
urs
Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15
Clinics Attended Target Attendance
Pre-QIP attempts,
including rota’d weeks & CMT-led
efforts
Survey refinements,
targeted elderly care and neuro
Survey cycles 1-3 presented to dept
and CMTs
School of Medicine visit, managerial
engagement
Letter sent to all supervisors and
CMTs
//
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Run Chart
0
0.1
0.2
0.3
0.4
0.5
0.6
Jan-Aug Aug-Sep Sep-Nov Nov-Dec Dec-Jan Jan-Mar Mar-May
Mea
n N
o. C
linic
s A
tten
ded
per
wee
k p
er C
MT
in w
ork
ing
ho
urs
Run Chart Summarising CMT Clinic Attendance and Interventions to Improve it, Addenbrooke's Hospital 2014-15
Clinics Attended Target Attendance
Pre-QIP attempts,
including rota’d weeks & CMT-led
efforts
Survey refinements,
targeted elderly care and neuro
E-Hospital introduced
Survey cycles 1-3 presented to dept
and CMTs
School of Medicine visit, managerial
engagement
Letter sent to all supervisors and
CMTs
Severe bed crisis
//
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Results
High workload on
the ward
Being the only junior
doctor on a firm
Lack of consultant
support in getting to
clinics
DME
Diabetes
Gastroenterology
Haematology
Hepatology
Infectious Diseases
Intensive Care
Neurology
Oncology
Renal
Respiratory
Stroke
Transplant
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Results
0
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1
1.2
Mea
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MT
in w
ork
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ho
urs
Medical Specialty
CMT Clinic Attendance by Specialty Sept-Dec 2014 (pre-intervention) v Mar-May 2015 (post-intervention)
Sept-Dec 2014 Mar-May 2015
TARGET
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• Mean clinic attendance rose
– 0.10 clinics/week/CMT at the start
– 0.53 clinics/week/CMT by May 2015
• Variation between firms
• The majority of firms show a considerable improvement in clinic attendance over the year
Results Summary
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• Keys to success
– Engagement
– Objective data
• Barriers to success
– Increasing clinic requirements
– Persistent challenges
• Lessons learned - improving clinic attendance is:
– Possible…
– But not easy!
– Valued by trainees
Keys To Success, Barriers and Lessons Learned
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Dr Sanjay Ojha
All of the CMTs who have completed the surveys
All of the clinical firms who have engaged with this project
Acknowledgements
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Hig
h w
ork
load
on
th
e
war
d
Bei
ng
the
on
ly ju
nio
r
do
cto
r o
n a
fir
m
Lack
of
cove
r p
rovi
ded
by
the
rest
of
the
firm
Inex
per
ien
ced
fo
un
dat
ion
year
do
cto
rs
Lack
of
app
rop
riat
e cl
inic
s
in y
ou
r sp
ecia
lity
Lack
of
info
rmat
ion
rega
rdin
g cl
inic
s
Lack
of
con
sult
ant
sup
po
rt g
etti
ng
to c
linic
s
Lack
of
regi
stra
r su
pp
ort
in g
etti
ng
to c
linic
s
Lack
of
clin
ic r
oo
m s
pac
e
or
equ
ipm
ent
Lack
of
sen
ior
sup
po
rt
wh
en in
clin
ic
e-H
osp
ital
tra
inin
g
e-H
osp
ital
aft
er ‘g
o-l
ive’
DME
Diabetes and Endocrinology
Gastroenterology
Haematology
Hepatology
Infectious Diseases
Intensive Care
Neurology
Oncology
Renal
Respiratory
Stroke
Transplant
Results