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Article 3. Complaint management, project management and broken ECG machines: all in a day's work
  1. Correspondence to: Mr Wardrope (Jim.Wardrope{at}northngh-tr.trent.nhs.uk)
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Wardrope J, McCormick S
Article 3. Complaint management, project management and broken ECG machines: all in a day's work

Publication history

  • First published July 1, 2001.
Online issue publication 
July 01, 2001
  • SIMS ARTICLE 3: INTERNET PAGES

    The Internet pages are divided into "feedback" and "in tray". Feedback gives some of the actions taken over the previous management problems.

    Article 3 - FEEDBACK

     

    SWOT ANALYSIS. CONFIDENTIAL FOR DR YORK ONLY.

    STRENGTHS

    Good workload and in good geographic position.
    Reasonable SHO numbers
    SpR training
    Staff grade posts
    Good nursing staff
    Good speciality mix in inpatient teams.

    WEAKNESSES

    Mr. London
    Training report
    Long waits at weekends
    Poor physical space.
    Equipment poor (old ECG machines, no blood gas machine)
    Nursing a bit "traditional"

    OPPORTUNITIES

    Improve waiting times
    ? A&E Modernisation money
    ? ENP
    Improve teaching program

    THREATS

    Waiting times
    Trolley times
    Increasing workload
    Some specialities not helpful
    Withdrawal of training recognition.

    3 key actions:
                                Discuss with Mr London
                                Time out with A&E staff
                                Discuss with management - probably at CEO meeting

     

     

    PROPOSED SHO TEACHING PROGRAMME

     

    Week

    Topic 1

    Topic 2

    Topic 3

    1

    Cardiac Emergencies
    Dr York

    Mini ALS
    Dr York, Dr Ireland & Miss Devon

    2

    Trauma
    Mr London

    Mini ATLS
    Mr London, Dr York & Mr Bathi

    3

    The Sick Child I
    Mr London

    Mini APLS
    Mr London, Dr Ireland & Dr Wales

    4

    Emergency Radiology I
    Dr Xavier Ray

    Ophthalmology in A&E
    Mr U V Itis

    Fractures I
    Mr Bathi

    5

    Dealing with Relatives
    Sister Lisa Ash

    Epilepsy
    TBA

    The Major Incident Plan
    TBA

    6

    Wound Management
    Dr York

    Childhood Illnesses
    Dr H Hamley

    How to Teach
    Miss Devon

    7

    Fractures II
    Dr Wales

    Emergency Radiology II
    Dr Xavier Ray

    GI Bleeding
    TBA

    8

    ENT Emergencies
    TBA

    The Sick Child II
    Mr London

    SHO Presentations
    TBA

    9

    Headaches
    TBA

    Spinal Cord Injuries
    TBA

    SHO Presentations
    TBA

    10

    Funny Dos in the Elderly
    Miss Devon

    Shock
    Mr London

    SHO Presentations
    TBA

    11

    ATLS, ALS & APLS Revision
    Dr York, Dr Ireland & Mr Bathi

    12

    Infectious Diseases
    TBA

    Respiratory Emergencies
    TBA

    SHO Presentations
    TBA

    13

    Joint Examination
    Dr Wales

    Head Injuries
    Mr T Nutcracker

    SHO Presentations
    TBA

    14

    Management Exercise
    Dr York

    Emergency Psychiatry
    TBA

    SHO Presentations
    TBA

    15

    Non-Accidental Injuries
    Dr H Hamley

    Drugs & Alcohol
    Dr Ireland

    SHO Presentations
    TBA

    16

    Obs & Gynae In A&E
    TBA

    Poisoning
    Mr Bath

    SHO Presentations
    TBA

    17

    Medico Legal Problems
    Mr London

    Abdominal Pain
    TBA

    SHO Presentations
    TBA

    18

    Audit & Research
    TBA

    Communication Skills
    TBA

    SHO Presentations
    TBA

    19

    Smoke Inhalation
    Miss Devon

    Burns and Scalds
    TBA

    SHO Presentations
    TBA

    20

    Back Pain
    Mr AO Screw

    Social Services
    TBA

    SHO Presentations
    TBA

    21

    Diabetes
    TBA

    Haematology Emergencies
    TBA

    SHO Presentations
    TBA

    22

    Dental Emergencies
    TBA

    Vascular Problems
    TBA

    SHO Presentations
    TBA

    23

    Urological Emergencies
    TBA

    Hand Injuries
    TBA

    SHO Presentations
    TBA

    24

    SHO Presentations
    TBA

    Pain Management
    TBA

    SHO Presentations
    TBA

    25

    Dermatology in A&E

    Stress in Medicine
    TBA

    SHO Presentations
    TBA

    26

    Job Review, Feedback and Quiz
    Dr York & Mr London

     

     

    FILE NOTE OF TIME OUT WITH A&E STAFF (DR YORK)

    Did SWOT analysis and  the staff mostly agreed with my own thoughts.
    Main problems identified were long waits especially at weekends, very poor equipment and accommodation and problems with finding beds. Nurses were a bit frustrated about restriction of extended roles. Doctors felt that the nurses could do more such as ECG�s , bloods and simple suturing.
    Nurses thought that some doctors did not work efficiently and this meant long waiting times. SHOs spend a lot of time in writing notes. Nurses felt a bit unsupported by senior medical staff.
    Very clear vision that we want to be an excellent DGH A&E.

    Service objectives - Cut waits for minors. Improve trolley times. ENP. Extended roles. More senior doctors.

    Teaching objectives - No nurse teaching at present: start nurse education program. Improve SpR teaching/training.. Improve SHO teaching. ? Start ATLS course.

    Management objectives - Improve influence on the directorate. ? Move to general medicine. ? Own directorate. Regular staff meetings with reps from all staff groups       and grades. Start planning for new building. GET MORE EQUIPMENT!!

    Audit/research - Start some regular sessions with all staff on audit- start with waiting times. Examine reasons for Trolley waits. SpR projects in audit. Nurse audit of patients that could be seen by nurse practitioner. ? Consider participation in multicenter trial.

     

     

    LETTER FROM DR YORK RE REQUEST FOR MORE INFORMATION

    Dear Mrs. Penny,

    Thank you for your letter and the request for more information. I can add little to the facts. I have talked to the staff again and both are clear that meningitis was in the differential diagnosis. The SHO says that he said this when he referred the case to the medical registrar.

    I can assure Mrs. Green that Janice�s learning problems did not mean that she had less care. On the contrary we try to be extra careful in patients where the communication may not be easy.

    As I have said previously I would welcome and the chance to discuss this directly with Mrs. Green.

     

     

    LETTER FROM THE TRUST TO MRS GREEN

    Dear Mrs. Green,

    Thank you for your letter. We have asked for further information. The A&E department and the medical department would like to re-assure you that Janice�s learning problems would not in any way affect the level of care. Indeed the doctors are aware that they need to be extra careful when there might be communication problems. The main problem seems to be that the symptoms and signs were not typical of meningitis and the doctor thought a water infection a much more likely cause of the fever.

    Dr. York the A&E consultant would be happy to meet you and to discuss these problems. If you would like to do this please contact Mrs. Penny our Quality Co-ordinator on the telephone number given above.

    Again the staff and myself wish to convey our condolences and are willing to answer any further questions .

    Ms. Butcher

     

     


     

    Article 3 - IN TRAY

     

    Letters of complaint about waiting time and letter from Dep. Chief Exec.

    Dear Dr. York,

    I believe that you were on duty last weekend. I was the duty manager and I took two separate complaints about waiting times is the A&E department. I have passed these onto the Patient Partnership department and no doubt you will be asked to comment through the normal complaints procedure. However I believe that Ms. Butcher has already asked for your advice on this problem. The Trust Board wishes some action on this issue. The improvement in waiting times in A&E departments is one of the main targets listed in the National Plan for the NHS and I would be grateful for your plans on how to improve the situation.

     

    Dear Dr. York,

    Please find enclosed two complaints that were received by telephone last weekend. I believe you were on call. I would be grateful if you could investigate the issues raised and reply within two weeks.

    Mrs Penny

    --------------------------------------------------------------------------------------------------------------------

    Two Complaints

    • I waited 5 hours to see a doctor. I saw Dr York. She was very rude and said that I should have gone to my GP with my painful knee. I did this and my GP has sent off an immediate request for an urgent appointment with a specialist. Obviously there is something seriously wrong and I hope you will take action against the uncaring Casualty doctor.
    • I realise that Accident and Emergency doctors are very busy especially at weekends but I had to wait 6 hours with a cut to the finger that needed two stitches and a tetanus injection. Could this not have been done by a nurse and so freeing the doctor for more urgent cases. I do not usually complain but I feel that with some thought it should be possible to improve the service for such minor problems.

    NEED REQUEST FOR INDEPENDENT REVIEW.

    --------------------------------------------------------------------------------------------------------------------

    Note from Sister Ash

    • Last night the ECG broke down. The "back up" is so ancient that we could not find any paper for it. I had to go personally to Ward 6 to borrow their machine AND TAKE IT BACK!!!!. We have been asking for a new machine for ages. All other wards seem to have "pagewriters" that make it so much better to put in the notes. Can you do something about this? The nurses are fed up and frustrated. Ta.

    --------------------------------------------------------------------------------------------------------------------

    Letter from Deputy Chief Exec about legal claim.

    (for those that acted on the "results" then this does not apply).

    Dear Dr. York.,

    As you may know, one of my responsibilities (with the Medical Director) is that of Clinical Governance. The enclosed letter from solicitors seems to highlight a problem with your risk management procedures. I wonder if you could send me the departmental policy on the review of tests and recall of patients.

    Dear Sirs.

    Re- Karen Sims

    We would like to apply for full disclosure of the medical records for the above patient to investigate a possible claim for negligence. Our client instructs us that she attended your department after a road traffic accident when she injured her neck. She was told the X-ray was normal. She consulted her GP as she continued to have symptoms. Her GP was informed that the X-ray was not normal and our client has been referred urgently as a private patient to a neurosurgeon. The prognosis is not certain but our client is severely disabled at the present time.

    We seek voluntary disclosure under the pre-action protocol. Please reply within 14 days or we will commence formal proceedings.

     

     

    Waiting time statistics

     

    Day

    % seen within 1hr

    % seen 2 hours

    % waiting > 4hrs.

    Mon

    47

    69

    5

    Tues

    56

    71

    3

    Wed

    65

    77

    1

    Thurs

    70

    77

    10

    Fri

    65

    79

    5

    Sat

    30

    50

    15

    Sun

    30

    45

    11

     

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