Newshound

Trust forced to cut training

Publication date:  04 Nov 2009

A deanery has asked a trust to withdraw GP and Acute Care Common Stem (ACCS) CT1 trainees from night duty in an emergency department because the trust could not show that the level of cover was consistent with the delivery of high standards of patient safety.

Maidstone and Tunbridge Wells Trust had been using recently qualified doctors to work between 12 midnight and 8 am, according to the College of Emergency Hospital Medicine.

But during a regulatory visit by the Postgraduate and Medical Education Training Board (PMETB) in July, concerns were raised about the lack of direct clinical supervision of junior trainees out of hours.

The college says it is aware that many emergency departments throughout the UK and Ireland do not have 24 hour middle grade cover provided by non-consultant doctors at ST4 level or above.

“The college holds the strong view that all emergency departments should have doctors with ST4 or above competencies in post 24/7 by 2012,” said a spokesperson. “The college would be happy to provide advice on the mechanisms by which this can be achieved and the key indicators of patient safety.”

The college has drawn up a checklist that should ensure some level of safeguard until such conditions can be achieved. Its recommendations include:

• Clear clinical guidelines and pathways of care

• Clear protocols for when and how to ask for senior help in the emergency department

• An active Hospital at Night team to support the emergency department

• Clear guidelines of the trauma team and how to activate it

• Evidence of robust handover of emergency department patients, which must include involvement of senior medical staff, at least twice a day.

A spokesperson for PMETB said that all postgraduate deans had a right to remove trainees if necessary and the problem in this particular case was “multi-factorial.”