Top Tips for Working Time Directive Compliance

With the clock to Working Time Directive continuing to tick closer and closer to the deadline of 1st August 2009, Calling Time has compiled a list of essential tips from a host of healthcare organisations who have successfully implemented the directive.



Acute Response Team (ART):
The Royal Liverpool and Broadgreen University Hospitals NHS Trust

Hospital at Night to Hospital at Day

• Hospital at Night team to provide expertise on nurse led out of hours service. Coordinate ART on a day to day basis
• Members of ART provide regular feedback on the effectiveness of the junior doctor team and any impact on their training opportunities
• Ward managers to provide insight into ward staff’s requirements for medical cover
• Close links developed with the Critical Care Outreach team to prevent duplication. Team also assists with staff training
• Monitor the effects of ART. Any clinical incidents linked to the team are reported to the project manager
• Clinical Information Department produce audit tool to monitor the effectiveness of ART
• The resuscitation manager provides expert advice on current systems and assists in staff training.

Royal College of Obstetricians and Gynaecologists and Royal College of Paediatrics and Child Health

Taken from: Children’s and Maternity Services in 2009: Working Time Solutions - Recommendations for paediatric and child health services when planning WTD compliance

• Good planning and implementation are key factors in the success of these roles in helping to achieve WTD compliance
• Units should put in place succession planning for these roles so staff that leave can be replaced quickly
• Units should make themselves aware of the lessons learnt by units who have used these roles successfully.

Consultants

• Units using a consultant of the week system reported that it contributed to improved patient safety, better continuity of care, training, supervision and improved consultant support for trainees
• Consultant presence in the evening can improve triage and efficiency of the unit overall, plus potential benefits on patient safety and training
• A consultant resident on call day and night can reduce the workload overall within the unit in out of hours periods and benefits on patient safety and training.

Practical WTD tips from the Homerton University Hospital NHS Foundation Trust

Christine Blanshard, consultant physician

• Know your hospital. One model does not fit all so gather as much background information as possible: number of emergency attendances, time of arrival, numbers and types of admission, length of stay, numbers of emergency operations
• Consider all potential solutions and ideas, but innovate your own
• Try getting everyone to agree change that needs to be made
• Don’t underestimate the amount of time required to make change happen, it took the Homerton around four years
• Numbers information and data can be very persuasive. Speak to each consultant team individually to show how the changes will effect them
• Improvements can always be made.

Stockport NHS Foundation Trust

• Regular operational meetings
• Management team to visit all sites for regular communication
• Clinical involvement is essential
• Create champions to help promote scheme to fellow staff
• Set measurable targets from the outset.

WTD Compliance Tips from Royal College of Anaesthetists and Royal College of Surgeons

Taken from: WTD - Implications and Practical Suggestions to Achieve Compliance

• Ensure senior board level leadership
• Encourage junior doctor involvement
• Establish a WTD steering group
• Use IT solutions
• Redesign services if needed
• Implement as soon as possible to ensure solutions are monitored, embedded and implemented.

Top Tips for WTD Rota Design

• Consult with all key stakeholders before planning any changes - junior doctors, senior doctors, senior nursing staff
• Identify local workload and match medical staffing levels appropriately
• Realistic start and finish times in the normal working day
• Minimise impact upon attendance at formal teaching sessions
• Include appropriate handover period
• Include appropriate prospective cover allowance and room for leave to be taken
• Ensure New Deal and WTD requirements are all met
• Ensure rotas are IWL friendly eg maximise number of free weekends
• Plan rotas with flexibility ie not 47.9 hours
• 13 hour shifts are likely to overrun so aim for a maximum of 12.5 hours
• Group weekend nights together
• Match doctors in pairs / consider daytime ward cover
• Match rotas at different grades within specialities to allow joint handover / Hospital at Night / team working
• Use a software package like DRS or Zircadian to analyse rotas and ensure that staff using the software have been trained appropriately
• Wherever possible senior surgical trainees should be removed from night shifts or consider non resident on call in order to consolidate learning, maximise daytime training opportunities and ‘cutting time’.