The first Wednesday of August in England is known by some observers of the NHS as ‘Black Wednesday’, the more cynical ones calling it the start of ‘the killing season’.
Recent studies show there are 6 – 8% more patient deaths in the first week of August than in the last week of July. Although at first glance this is scary, it does need careful and cautious interpretation as it does not demonstrate a causative link between junior doctor errors and patient deaths.
With over 6,000 junior doctors starting new posts, some of them for the first time, it is no surprise that this is a worrying time for hospital staff, hospital risk managers and the public. Coincidentally perhaps, ED attendances have fallen over recent years on this particular day; perhaps it reflects public awareness of this phenomenon.
The Academy of Medical Royal Colleges (AMRC) have called for action to be taken. Although attempts have already been made to reduce the number of serious untoward events, it is clear that general standards of patient care including length of hospital stay need improving during this critical period.
It does not take a rocket scientist to work out that a supervised induction period will lead to better overall preparation for junior doctors and should improve patient care. A ‘shadowing’ initiative, suggested by the AMRC, has been piloted by several UK trusts with some success. On paper it is an excellent initiative; in practice however, how practical is it in a fast-paced and time critical environment such as an emergency department where changeover day only serves to stretch the already overstretched staffing debt? How can we ensure appropriate senior doctor/consultant cover during this critical period?
Induction should focus on systems, communication, crew resource management and patient safety. Standard systems and protocols nationally will certainly be one solution, as well as placing junior doctors in hospitals where they have trained as medical students; local knowledge will help.
Staggering the changeover period is another option; the downside is that a five-day induction stretches resources and not all hospitals with have the infrastructure to manage this safely.
Patient care is an absolute priority at all times but especially so during this time; we need to continue to support and encourage our junior doctors who are often facing one of their most difficult and challenging times of their professional lives.
Janos P Baombe/Sivanthi Sivanadarajah