A senior registrar 'shadowed' a district general manager and a unit general manager for one week each as a management training exercise. The three principal participants describe the exercise from their different perspectives. Consequent issues and the value of such 'shadowing' as a mode of training are discussed.
The aim of this quality improvement project was to review the interagency safeguarding referrals completed at a district general hospital before and after the implementation of the project's initiatives. The quality of the referrals was evaluated based on the accuracy and clarity of documented information. The project also focused on evaluating how long after the patient encounter the referrals submitted. These were assessed against Working Together for Safeguarding Children 2018 and the NICE Clinical Guideline CG89 Child Maltreatment: when to suspect maltreatment in under 18s. Methods During the first cycle, sixteen interagency referrals (IAR) submitted in March 2020 through the local electronic records system were retrospectively reviewed using a previously devised proforma from 2016. Following analysis, the electronic IAR on the local care records system was modified by simplifying the questions and specifically asking about concerns and outcome if no action were taken. Healthcare professionals were presented with the initial results and received an education session about using the form. In the second cycle, nineteen IAR forms were retrospectively reviewed in August 2020.Results Nursing staff and junior doctors completed majority of the forms. In March 2020, 75% of the forms used clear language with no medical jargon and this improved to 100% of the forms submitted in August 2020. In terms of accuracy, school's and family members' details were commonly missing. In March, school name was documented in 25% of referrals and following intervention this improved to 37%. There was an increase in accuracy of completing parent and carer details which increased from 75% to 83% as well as documentation of communication needs of the child and family, increasing from 81% to 95%. In addition, there was a significant improvement in the clear documentation of concerns from 38% in March to 79% in August. The description of the risk to the child if no action was taken, also improved from 13% to 26%.Prior to interventions, all forms were completed within 48 hours of patient encounter and 63% within 24 hours. After the interventions were implemented, 94% of the forms were submitted within 24 hours. The only exception was a delay in a form submitted following repeated missed attendances which raised safeguarding concerns. Conclusions These interventions facilitated the social care team in risk-stratifying patients and optimising management of safeguarding in children. Completing a re-evaluation has also surfaced further areas of improvement; in particular communicating the anticipated detrimental consequences to a child if the seriousness of the concern is not conveyed appropriately. Overall, this project successfully targeted education to relevant healthcare professionals and improved accuracy and timeliness in the completion of IARs.
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