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8 General surgical foundation doctor optimisation of daily practice
  1. Emmanuel Feldano1,
  2. Ben Ramasubbu2
  1. 1NHS Grampian
  2. 2NHS Aryshire and Arran

Abstract

Introduction Traditionally the role of a surgical foundation year 1 (FY1s) doctors consisted of long working hours, multiple on call shifts and little to rest however, the introduction of European working time directive now means that FY1s are constricted to 48 hours per week on average and various other regulations that junior doctors should abide by yet the same quantity of daily tasks remains the same. In this study we looked at the difficulties FY1s now face in their daily working day and if some of these issues could be resolved by implementing some structural changes.

Methods The study was conducted in three cycles, each lasting five days (Monday to Friday). Cycle 1 included shadowing of Surgical FY1s on wards for five consecutive days observing daily routine (arrival, lunch and departure time), task completion, communication and handovers. Following this multiple interventions were made to the structure of their daily practice to improve productivity and performance. These improvements were measured in cycle 2 (as the new model was scaffolded into place) and cycle 3 (strictly observed).

Results In cycle 1 we observed that 100% of F1s arrived to work on time, there was no set times for lunch and all of the FY1s lunches were interrupted. There was no structure for handovers and 100% of F1s stayed at work beyond there contracted hours. In second cycle, 100% of F1s had lunch between the hours of 12pm-1PM on 3/5 days and 75% on the remaining two days. 75% of F1s had uninterrupted lunches on all 5 days. Morning and afternoon handovers were completed every day. In cycle 3 the results remained as high. There was no significant difference in number of tasks between week 1, 2 and 3.

Conclusion Through the implementation of daily structure and other interventions involving the multidisciplinary team we improved the quality of F1s working day and increased the efficiency of service delivered on the surgical ward.

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