In the 30 November edition of the BMJ I was struck by a publication and accompanying commentary from Moscelli and colleagues which showed higher monthly turnover rates of hospital nurses and senior doctors were associated with higher mortality risks for patients after emergency admission to hospital.
We know that organisational factors such as culture, staffing, and retention are crucial to patient safety. The stress, moral injury and demands of working in overcrowded and overstretched ED’s and acute assessment areas has been well documented. The turnover of nursing staff, particularly at Band 5 level, is significantly high and the turnover of nursing staff shows a stronger association with mortality than that of medical staff.
This study supports what many of us felt working in ED’s now compared to earlier in our careers; staff turnover is high and understanding the ‘way we do things here’ and demonstrating an ‘organisational memory’ for new starters to be able to read and assimilate knowledge and standards for working in a new department is essential. We’ve had short term turnover of medical staff for a number of years with medical rotations, be it 4 months or 6 months. In both cases the ability to put together an induction and playbook has been seen to be increasingly vital. In my early years in the ED this focussed on the management of minor injuries or antibiotics choices, but increasingly now this needs to include taking handover of patients waiting admission or how to run the observation unit.
Central to providing this information is a system such as CEMBooks, created by ED clinicians to help with exactly these issues. It includes a phone book for easy access to phone numbers, a resource repository for guidelines and Standard Operating Procedures (SOPs), and the ability to customise logs to provide daily briefs, educational learning SBARs and handover tasking. It’s all stored and easily searchable and accessible on web or app and this is how you create a department memory bank for new or returning staff to be able to read through and familiarise themselves with when getting up to speed with how the department works.
A great example of this are educational SBARs as outcomes from Patient Safety Incident Response Framework (PSIRF) investigations or clinical case updates from SIM sessions. New starters can read and learn from these, reference them multiple times if needed and link to current management protocols. Learning can be started and remains searchable and accessible.
You can’t always change the number of patients in your department or control the outflow, but you can impact how you support your staff, how you onboard them, how you provide them with the tools and information to do their job and to treat patients safely and consistently.
This is something CEMBooks can help with. For a demonstration or further information please contact our team.
If you’ve not yet seen the BMJ 2024;387:e079987 research study it’s available on this link.
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