5 November 2019

Making paediatric emergencies less stressful for trainees

To improve care quality, it’s important to ensure that those who deliver care are well looked after. Emergency clinical situations are inherently stressful, not just for patients and their loved ones, but for the staff attending as well. In emergency settings there’s a higher chance that error will occur, as staff are required to act quickly and under a great deal of pressure.

Valerie Lan-Pak-Kee, a junior doctor at Barts Health NHS Foundation Trust, attended a paediatric emergency and found the situation very stressful. With support from UCLPartners Aspiring Improvers programme, Valerie and her colleague Nav-Preet Kaur, another junior doctor, were able to establish resources to reduce stress and anxiety for trainees in paediatric emergencies.

Valerie and Nav-Preet began by surveying their fellow junior doctors at Barts, to find out what factors caused the highest levels of anxiety in this particular setting, and what trainees thought would help to alleviate this stress. They also undertook walk-through simulation scenarios to highlight obvious opportunities for improvement.

Cheat sheets to help calculate anaesthetic dose
One of the anxiety-inducing scenarios junior doctors flagged was calculating anaesthetic dose in an acute setting. This is calculated according to the patients’ weight and requires junior doctors to do quite complex arithmetic during a very stressful situation. So, Valerie and Nav-Preet produced a cheat-sheet for the most common anaesthetic drugs with dose per kilo and volume of standard concentration per kilo, that doctors could refer to easily in emergency situations. These cheat sheets were laminated and displayed in A&E resuscitation areas and distributed as an image for doctors to have on their phones.

Checklists for transfers
Another major cause of stress and anxiety for trainees in any emergency is when patients need to be transferred to a different department, and in some cases, a different hospital. They decided this could easily be addressed with a checklist of standard items anaesthetised patients and the staff looking after them need to have. This equipment included simple items that could well be forgotten such as a fully charged phone; warm clothes; food and money for getting back to the base hospital. The list was a simple aide memoir distributed to trainees.

“My advice to any future improvers would be to make projects simple and cost effective. The easier ideas are to implement the more likely they will be met with approval and cooperation.”Nav-Preet Kaur, Junior Doctor, The Royal London Hospital

Although Valerie and Nav-Preet appreciated there might be some resistance to any new changes in the A&E department they found that most junior doctors were appreciative of the new resources. They had the backing of the anaesthetic paediatric lead and the A&E paediatric lead, which meant that distributing and displaying resources was easy to do.

Valerie and Nav-Preet both took part in the 2017 UCLPartners Aspiring Improvers Programme.