Authors: Mark Jenkins, Elisaveta Sokolov, Sophie Rintoul-Hoad, Mark Kinirons, Adrian Hopper
Building on Atul Gawande’s work on using checklists to support more reliable systems, we developed and implemented a simple checklist to ensure the objectives of shadowing were systematically covered. These included orientation to clinical teams, environment and information technology systems, patient safety issues (such as falls, delirium, prescribing, and venous thromboembolism), and core aspects of the rotation (such as rotas, on-call responsibilities, and who to contact for advice during working hours and out of hours).
The checklist is not specific to individual specialties as its objectives are integral to every foundation year role. Its simple two sided format helps tackle the problem of “information overload,” allowing clear prioritisation of the knowledge that needs to be transferred. This builds on the growing understanding of the role checklists have across healthcare and helps new graduates become familiar with their use at an early stage.
The Dr toolbox enabled us to cover any gaps from shadowing, facilitate the transfer of tacit knowledge, and provide a more robust guide to our large foundation trust. We recognise that hospital specific guides are not new, but internet platforms allow quick and widespread access and this matches how junior doctors now access clinical information.
To deal with concerns about inappropriate or erroneous content, editing is restricted to nominated junior doctors with senior supervision at each hospital, and these senior supervisors facilitate contributions. This is an improvement on trust intranet systems, where information is often difficult to find, quickly becomes out of date, and may not contain practical tips on carrying out jobs efficiently. Requiring junior doctors to be responsible for this information can engage them early on in process improvement and patient safety.
A key advantage of this project, like the World Health Organization surgical checklist, is that it is sustainable, scalable, and reproducible and can improve quality and safety without requiring appreciable financial resources.