New doctor rota in death rate link

Salisbury Journal: More patients die on 'black Wednesday' when newly-qualified doctors start their hospital duties, studies show More patients die on 'black Wednesday' when newly-qualified doctors start their hospital duties, studies show

Staggering junior doctors' training rotations could help to prevent the "black Wednesday" phenomenon, medical experts have said.

Studies have previously linked the first Wednesday in August, the day when freshly-qualified doctors arrive on hospital wards, to higher death rates among patients.

This day also coincides with a changeovers in the training schedules of junior medics who have already been working in the hospital.

Now the Academy of Medical Royal Colleges has recommended that while all Foundation Year 1 - junior doctors in the first year of the programme which forms the bridge between medical school and specialist training - should commence work on the first Wednesday in August, junior doctors already working in hospitals should not change over departments until September.

The Academy said that this will mean that the newest doctors will always work with trainees who have already been doing the job for a number of months.

This, on top of an existing scheme whereby newly qualified doctors "shadow" senior colleagues for the first few days, should help to address the issue, a spokeswoman said.

Its latest report, Staggering Trainee Changeover, states: "There is a clear need for change in the process of trainee doctor changeover (the time when junior doctors rotate their position).

"The beginning of August brings an apparent increase in patient morbidity and evidence suggesting increased mortality. It is a time that trainee doctors find stressful and difficult.

"This paper recommends that the most effective solution for safe trainee changeover is a roll forward model of staggering, where the more senior trainees rotate one month later.

"These changes would ensure that new junior doctors in training would be supported by senior trainee doctors, who would have already been in the post for five to 11 months."

Dr Simon Newell, co-author of the paper and chair of the Academy's staggered trainee changeover working group, said: "This has been an important piece of work which has been driven by concerns about patient safety.

"Evidence suggests that patients die because of the current arrangements. I believe our proposals, which were the subject of considerable debate and consultation, will improve quality of care and patient safety, and it is therefore important that this work, while it should form part of the Shape of Training proposals, does not get lost within its wider agenda."

Dr Andrew Collier, co-chair of the British Medical Association's Junior Doctors Committee, said: "All doctors in training strive to provide high levels of patient care at all times. It is essential that changeover arrangements protect continuity of care and support new doctors, preparing them for a different work environment.

"We have concerns about proposed changes to rotation arrangements that would lead to an enforced break in employment, as this can affect employment rights and benefits, such as redundancy entitlements and pension arrangements.

"To avoid a break in service, as well as a gap in doctors' training and income, the BMA has suggested that, if a staggered changeover is implemented, outgoing doctors should remain in post for an extra month to help with the induction of new trainees, or avail of training and development opportunities. This would benefit both patient care and doctors' training experience.

"Ultimately, we want employers and the Government to take action to make the changeover period less chaotic, addressing workload pressures on doctors and consider increasing staffing levels during the changeover."

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