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From revered to commiserated: the changing role of the medical registrar. 从尊敬到同情:医疗登记员角色的转变。
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-53
Nicholas Smallwood, Yee Yen Goh
{"title":"From revered to commiserated: the changing role of the medical registrar.","authors":"Nicholas Smallwood,&nbsp;Yee Yen Goh","doi":"10.7861/futurehosp.4-1-53","DOIUrl":"https://doi.org/10.7861/futurehosp.4-1-53","url":null,"abstract":"<p><p>The role of the medical registrar has changed significantly over the last few years, and in many respects this has not been for the better. Both the perception and the realities of the general internal medicine component of higher specialist training have led to significant pressures on recruitment to specialty training posts. Core trainees do not feel prepared to become the medical registrar and those in the role highlight substantial problems that impact on the quality of care they can deliver. This article aims to explore some of these difficulties and where possible suggest potential solutions; there needs to be urgent action undertaken to stave off a potential crisis in registrar recruitment and retention. Despite this, the role of the medical registrar remains a hugely fulfilling part of a physician's career, and there is much to be celebrated and embraced about the qualities a registrar brings to the successful functioning of both general and specialist medical teams.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"53-55"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484154/pdf/futurehosp-4-1-53.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Whither or wither the medical registrar? 医疗登记员是谁？
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-39
Andrew F Goddard
{"title":"Whither or wither the medical registrar?","authors":"Andrew F Goddard","doi":"10.7861/futurehosp.4-1-39","DOIUrl":"10.7861/futurehosp.4-1-39","url":null,"abstract":"<p><p>In 2013, the Royal College of Physicians published <i>The medical registrar: empowering the unsung heroes of patient care</i>. This report showed that workload, teamwork, training and flexibility were the key factors in determining job satisfaction and morale for medical registrars. Since the report, some progress has been made in each of these four areas. Reduction in workload by development of new parts of the hospital workforce has started and the junior doctors' industrial action has forced the NHS and employers to look afresh at both workload and training aspects. The creation of chief registrars and guardians of safe working has started to create a supporting framework to improve professional working lives and training. Teamwork and support from consultants is perhaps the biggest opportunity to improve matters. However, the NHS remains inflexible and making the medical registrar post attractive to those in earlier stages of training is the biggest challenge.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"39-43"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484172/pdf/futurehosp-4-1-39.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
The future physician. 未来的医生。
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-61
Halima Amer, Frank Joseph
{"title":"The future physician.","authors":"Halima Amer,&nbsp;Frank Joseph","doi":"10.7861/futurehosp.4-1-61","DOIUrl":"10.7861/futurehosp.4-1-61","url":null,"abstract":"<p><p>Both hospital-based care and physician training have undergone significant changes within the past decade. Current physician training in the UK is failing to meet the needs of patients, with significant numbers of acute and general medicine posts unfilled. Building on the themes of the 2013 <i>Shape of Training</i> review, we propose a model that places an alternative model of generalist - the 'future hospitalist' - at the centre of patient care and medical training. The reinstatement of the general physician at the heart of hospital care will increase flexibility in both training and workforce planning, and embed active leadership, patient safety and quality improvement in care delivery.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"61-66"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7861/futurehosp.4-1-61","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Dermatology consultations: how long do they take? 皮肤科会诊：需要多长时间？
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-23
Junie Li Chun Wong, Rosie Catherine Vincent, Ali Al-Sharqi
{"title":"Dermatology consultations: how long do they take?","authors":"Junie Li Chun Wong,&nbsp;Rosie Catherine Vincent,&nbsp;Ali Al-Sharqi","doi":"10.7861/futurehosp.4-1-23","DOIUrl":"10.7861/futurehosp.4-1-23","url":null,"abstract":"<p><p>The rising demand for dermatology services calls for more -efficient clinics. However, there is a lack of evidence to guide the allocation of time for dermatological consultations. Our study analysed 607 dermatology consultations led by 23 clinicians. Consultation lengths were found to be dependent on the grade of clinician seen, nature of attendance (new or follow-up) and nature of final diagnosis. The median times taken for all consultations involving general dermatological conditions or suspected skin tumours were 16.5 minutes (IQR 12.8-24.1) and 15.5 minutes (IQR 11.7-20.1), respectively (p=0.001). Consultations with new patients took longer than follow-up cases (p<0.001). Based on our results, new patients presenting with general dermatological conditions should be allocated 25 minutes per consultant-led consultation, while follow-up cases can be allocated 15 minutes per consultation. We recommend similar analyses of consultation lengths in other specialties to inform the development of efficient, specialty-specific clinic models.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"23-26"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7861/futurehosp.4-1-23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Discharge to assess: transforming the discharge process of frail older patients. 出院评估:改变老年体弱患者的出院过程。
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-30
Natalie Offord, Paul Harriman, Tom Downes
{"title":"Discharge to assess: transforming the discharge process of frail older patients.","authors":"Natalie Offord,&nbsp;Paul Harriman,&nbsp;Tom Downes","doi":"10.7861/futurehosp.4-1-30","DOIUrl":"https://doi.org/10.7861/futurehosp.4-1-30","url":null,"abstract":"<p><p>The 2012 Royal College of Physicians report <i>Hospitals on the edge</i> is clear that 'decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services - including their own service - are organised'. This paper describes a service redesign in which we have gained learning and experience in two areas. Firstly, a description of measured improvement by the innovation of redesigning the traditional hospital-based assessment of frail older patients' home support needs (assess to discharge) into their own home and meeting those needs in real time (discharge to assess). In combination with the formation of a collaborative health and social care community team to deliver this new process, there has been a reduction in the length of stay from completion of acute hospital care to getting home (from 5.5 days to 1.2 days for those patients that require support at home). Secondly, the methodology through which this has been achieved. We describe our translation of a Toyota methodology used for the design of complex cars to use for engaging staff and patients in the design of a healthcare process.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"30-32"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7861/futurehosp.4-1-30","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
Medical leadership - in the scrum or shouting from the sidelines? 医疗领导——在争抢中还是在场边大喊大叫?
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-37
Simon Constable
{"title":"Medical leadership - in the scrum or shouting from the sidelines?","authors":"Simon Constable","doi":"10.7861/futurehosp.4-1-37","DOIUrl":"https://doi.org/10.7861/futurehosp.4-1-37","url":null,"abstract":"<p><p>As has often been the case in its nearly 70-year history, the NHS finds itself in difficult times with very real clinical and financial sustainability challenges and a need to transform itself. The vision has been laid out in the <i>Five Year Forward View</i>, but if there was a 'how-to' manual for delivery it could be argued that it isn't always completely clear and some chapters are incomplete. In the context of change in the modern NHS, medical leadership is often spoken about as being key and yet what this means varies between different people and at different times and on a whole spectrum of scale, from small projects to whole health-economy redesign. This article consists of some personal reflections on what it feels like to be in the midst of both.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"37-38"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7861/futurehosp.4-1-37","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Now, where are those matches at the end of this tunnel? 现在，隧道尽头的火柴在哪里？
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-5
Paul Jenkins
{"title":"Now, where are those matches at the end of this tunnel?","authors":"Paul Jenkins","doi":"10.7861/futurehosp.4-1-5","DOIUrl":"10.7861/futurehosp.4-1-5","url":null,"abstract":"The NHS is punch-drunk, lurching from crisis to crisis and poorly protected against the threat of a final flurry of knockout blows. Resources and funding consistently fail to keep pace with an inexorable increase in clinical demand; an imbalance severely compounded by a funding structure, designed in the 1940s, that patently cannot cope with the exigencies of the second decade of a new millennium. Blurred responsibilities between health and social care have resulted in overwhelmed emergency departments, inappropriate hospital referrals and bed shortages – and the rising tide of ‘black alerts’ should come as no surprise to anyone. Neither should the fact that morale among NHS personnel is now at an all-time low and we are faced with increasingly worrying deficits in staff recruitment and retention. The majority of hospital trusts and virtually all clinical commissioning groups (CCGs) in England are reported to be in dire financial straits, Simon Steven's 5-Year Forward Plan is now a 3-Year Forward Plan (having shown little sign of progression during the first 2 years of its existence) and the threat of industrial action by junior …","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484174/pdf/futurehosp-4-1-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37250690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Distributed leadership in action; the chief registrar. 分散的行动领导；首席注册官。
Future hospital journal Pub Date : 2017-02-01 DOI: 10.7861/futurehosp.4-1-11
Judith Tweedie, Lindsay Dytham, Sarah Campbell, Gerrard Phillips
{"title":"Distributed leadership in action; the chief registrar.","authors":"Judith Tweedie, Lindsay Dytham, Sarah Campbell, Gerrard Phillips","doi":"10.7861/futurehosp.4-1-11","DOIUrl":"10.7861/futurehosp.4-1-11","url":null,"abstract":"","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"4 1","pages":"11-12"},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484163/pdf/futurehosp-4-1-11.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37250693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Quality improvement: audio-visual tools are a valuable supplement when obtaining consent for lumbar punctures. 质量改进:视听工具是获得腰椎穿刺同意的宝贵补充。
Future hospital journal Pub Date : 2016-10-01 DOI: 10.7861/futurehosp.3-3-161
Alison May Berner, Claudia Craven, Faidra Laskou, Irene Baudracco, Neil Graham, Cath Mummery, Gordon Ingle
{"title":"Quality improvement: audio-visual tools are a valuable supplement when obtaining consent for lumbar punctures.","authors":"Alison May Berner,&nbsp;Claudia Craven,&nbsp;Faidra Laskou,&nbsp;Irene Baudracco,&nbsp;Neil Graham,&nbsp;Cath Mummery,&nbsp;Gordon Ingle","doi":"10.7861/futurehosp.3-3-161","DOIUrl":"https://doi.org/10.7861/futurehosp.3-3-161","url":null,"abstract":"<p><p>Neurological conditions present a challenge when obtaining consent for lumbar punctures (LPs), as patients often have -visual, hearing or cognitive impairments. The aim of this -project was to improve the quality of the consent process for LPs. Surveys of doctors and patients suggested there was scope to standardise and improve information provided during the consent process. A patient information video was -developed using online software and shown to patients using tablet -computers. Patient surveys were distributed to re-assess the quality of the process for obtaining consent. There was a -significant improvement (p=0.031) in the median response score after the video was presented to the same group of patients. The use of patient information videos -significantly improves understanding and recall of the procedure, and -satisfaction with the consent process. In conclusion, audio--visual tools are a valuable tool for standardising and -improving the process of gaining consent for LPs.</p>","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"3 3","pages":"161-164"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6465805/pdf/futurehosp-3-3-161.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37246500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Stories from patients and families: an invitation to a co-productive partnership in healthcare service. 来自患者和家人的故事：邀请他们在医疗服务领域建立合作伙伴关系。
Future hospital journal Pub Date : 2016-10-01 DOI: 10.7861/futurehosp.3-3-197
Maren Batalden
{"title":"Stories from patients and families: an invitation to a co-productive partnership in healthcare service.","authors":"Maren Batalden","doi":"10.7861/futurehosp.3-3-197","DOIUrl":"10.7861/futurehosp.3-3-197","url":null,"abstract":"The writer1 describes the central importance of human relationships – in healthcare services, in our efforts to improve quality and safety within healthcare, and in society at large. The work of healthcare professionals, although action-focused and often technologically complex, always takes place in the context of human relationships. These relationships unfold in place and time.\u0000\u0000The ancient Greeks had two words for time – chronos and kairos. Chronos time is measured sequentially in minutes, hours, months and years. Kairos time, by contrast, is an indeterminate duration – a season, a period, a moment – in which something of significance occurs. A daughter standing at the bedside holding her dying mother's hand waits in kairos time for the transition that will usher in the next chapter of her adult life. The health professionals attending to the patient in bed 3 work – for the most part – with diligence and good intentions, day and night, in ordinary chronos time, clocking in and clocking out. Although patients and families and health professionals may meet in the same physical location in a room in the ICU, they are existing in two different kinds of time.\u0000\u0000Health professionals and patients and families …","PeriodicalId":92635,"journal":{"name":"Future hospital journal","volume":"3 3","pages":"197-198"},"PeriodicalIF":0.0,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.7861/futurehosp.3-3-197","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37422190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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